3JA-19536-66765

4 vaccinations 6 coded responses 29 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 956 / CA
Registered: 2021-01-05

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-05
Registered in v-safe
2021-01-05
Dose 1 — Moderna
2021-01-05
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-02
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-03
Dose 2 — Moderna
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Good · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: For two days after vaccine #2

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Muscle spasms — Feeling: Fair · Headache, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Muscle spasms legs, feet , intercostals · Healthcare visit (other): Requested lab worked k+ and magnesium for potential source of spasms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-13
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-27
Survey response — day 21, dose 2
MedDRA: Balance disorder, Fatigue, Feeling abnormal — Feeling: Fair

Free text: Just generally not feeling like myself . Very tired and my equilibrium seems offkind of unbalancedl

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-10
Survey response — day 35, dose 2
MedDRA: Body temperature increased, Chills, Fatigue, Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Two days of temp to 101, aches and chills, extreme fatigue, a little better today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-05
Survey response — 3 months, dose 2
MedDRA: Dysphonia, Office visit, Tremor — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Hoarseness and shaky voice, shaky/tremors in hands since - mid Marchso far undiagnosed. · Healthcare visit (other): ENT, PCC, PET Scan, appt withEndocrine, not til June

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-06-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-04
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-19
Dose 3 — Moderna
2022-02-03
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-04-20
Dose 4 — Moderna
2022-04-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-27
Health check-in — day 7, dose 4
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-04
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-05-13
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-05-20
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-25
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-06
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-20
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-10-19
Survey response — 6 months, dose 4
MedDRA: Bone contusion, Hand fracture, Limb crushing injury, Loss of consciousness, Skin laceration, Wound closure — Feeling: Fair · 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: I blacked out in a hotel restaurant bathroom, broke fingers severely bruised ribs, crushed fingernails, 1.5 inch laceration through eyebrow/26 stitches, multiple tests but no diagnosis as to cause. All scans? MRIs , ultrasounds echocardiogram normal

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-10-20
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-05	Moderna
2	2021-02-03	Moderna
3	2021-11-19	Moderna	No
4	2022-04-20	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-08

Systemic reaction (other): For two days after vaccine #2

2021-02-09

Systemic reaction (other): Muscle spasms legs, feet , intercostals

Healthcare visit (other): Requested lab worked k+ and magnesium for potential source of spasms.

Release 4 — day 21, dose 2

2021-02-27

Symptoms: Just generally not feeling like myself . Very tired and my equilibrium seems offkind of unbalancedl

Release 5 — day 35, dose 2

2021-03-10

Symptoms: Two days of temp to 101, aches and chills, extreme fatigue, a little better today

Release 8 — 3 months, dose 2

2021-05-05

Symptoms: Hoarseness and shaky voice, shaky/tremors in hands since - mid Marchso far undiagnosed.

Healthcare visit (other): ENT, PCC, PET Scan, appt withEndocrine, not til June

Release 12 — 6 months, dose 4

2022-10-19

Symptoms: I blacked out in a hotel restaurant bathroom, broke fingers severely bruised ribs, crushed fingernails, 1.5 inch laceration through eyebrow/26 stitches, multiple tests but no diagnosis as to cause. All scans? MRIs , ultrasounds echocardiogram normal cut off by CDC

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	Muscle spasms	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Body temperature increased	✓	✓	✓
SD	Bone contusion	·	·	✓
SD	Chills	✓	✓	✓
SD	Dysphonia	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Hand fracture	·	·	✓
SD	Limb crushing injury	·	·	✓
SD	Loss of consciousness	·	·	✓
SD	Pain	✓	✓	✓
SD	Skin laceration	·	·	✓
SD	Tremor	✓	✓	✓
SD	Wound closure	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓

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