3EB-10067-74418

3 vaccinations 9 coded responses 22 check-ins 9 free-text entries 5 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 953 / CA
Registered: 2021-06-15

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-06-14
Dose 1 — Moderna
2021-06-15
Registered in v-safe
2021-06-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-06-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-06-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-06-21
Survey response — day 7, dose 1
MedDRA: Unevaluable event — Feeling: Good

Free text: I have a dark mark at the injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-28
Survey response — day 14, dose 1
MedDRA: Immunisation reaction, Lymphadenopathy, Pain, Pruritus, Rash papular — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I got Covid arm around the injection site 8 days later. Ive had a huge (9 x 11 cm) raised rash for a week thats mildly painful and itchy. The lymph nodes under that arm and in my neck swelled too.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-28
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-02
Call 1 — Left Voicemail
2021-07-05
Survey response — day 21, dose 1
MedDRA: Immunisation reaction, Lymphadenopathy, Rash — Feeling: Good

Free text: My Covid arm rash and swollen lymph nodes are gone.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-08
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2021-07-12
Dose 2 — Moderna
2021-07-13
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Dyspnoea, Palpitations — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Shortness of breath, heart palpitations, chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-13
Report sent to call center — days 1–6 daily, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-07-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-07-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-07-17
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Asthma triggered

MedDRA releases: 2024-11 · check-in free text available
2021-07-17
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-18
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Dyspnoea, Pre-existing disease — Feeling: Poor · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Vax triggered my asthma. On prednisone and nebulizer treatments now due to difficulty breathing.

MedDRA releases: 2024-11 · check-in free text available
2021-07-19
Survey response — day 7, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Asthma still triggered. Day 3 of prednisone and nebulizer treatments.

MedDRA releases: 2024-11 · check-in free text available
2021-07-22
Call 1 — Left Voicemail
2021-07-27
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-08-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-08-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-08-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-08-23
Survey response — day 42, dose 2
MedDRA: Colonoscopy, Musculoskeletal chest pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Increased rib pain following a colonoscopy

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-24
Call 1 — Left Voicemail
2021-09-01
Dose 3 — Moderna
2021-10-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-01-10
Survey response — 6 months, dose 2
MedDRA: Dyspnoea, Feeling hot, Headache, Oropharyngeal pain, SARS-CoV-2 test — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Sore throat, headache, shortness of breath, feverish (no fever) · Healthcare visit (other): Covid test

MedDRA releases: 2024-11 · check-in free text available
2022-01-10
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-11
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-06-14	Moderna
2	2021-07-12	Moderna	No
3	2021-09-01	Moderna	No

Call center

5 call center cases

1 successful · 4 unsuccessful

VAERS report filed, before or during a call: 1

See the call center timeline

Free text

Release 9 — day 7, dose 1

2021-06-21

Systemic reaction (other): I have a dark mark at the injection site.

Release 9 — day 14, dose 1

2021-06-28

Symptoms: I got Covid arm around the injection site 8 days later. Ive had a huge (9 x 11 cm) raised rash for a week thats mildly painful and itchy. The lymph nodes under that arm and in my neck swelled too.

Release 9 — day 21, dose 1

2021-07-05

Symptoms: My Covid arm rash and swollen lymph nodes are gone.

Release 9 — days 1–6 daily, dose 2

2021-07-13

Systemic reaction (other): Shortness of breath, heart palpitations, chest pain

2021-07-17

Systemic reaction (other): Asthma triggered

2021-07-18

Systemic reaction (other): Vax triggered my asthma. On prednisone and nebulizer treatments now due to difficulty breathing.

Release 9 — day 7, dose 2

2021-07-19

Systemic reaction (other): Asthma still triggered. Day 3 of prednisone and nebulizer treatments.

Release 9 — day 42, dose 2

2021-08-23

Symptoms: Increased rib pain following a colonoscopy

Release 10 — 6 months, dose 2

2022-01-10

Symptoms: Sore throat, headache, shortness of breath, feverish (no fever)

Healthcare visit (other): Covid test

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
HCVO	SARS-CoV-2 test	·	·	✓
SD	Colonoscopy	✓	·	✓
SD	Dyspnoea	·	·	✓
SD	Feeling hot	·	·	✓
SD	Headache	·	·	✓
SD	Immunisation reaction	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Musculoskeletal chest pain	✓	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash papular	✓	✓	✓
SRO	Asthma	·	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Unevaluable event	✓	✓	✓

✓ active code · ○ coded but marked inactive · blank = not in that release