3LM-16003-31464

3 vaccinations 8 coded responses 24 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 232 / VA
Registered: 2021-02-24

Relationship: Self
Race: Black or African American
Ethnicity: N/A

Timeline

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

2021-02-15
Dose 1 — Moderna
2021-02-24
Registered in v-safe
2021-02-24
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-01
Survey response — day 14, dose 1
MedDRA: Fatigue — Feeling: Fair

Free text: Tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-15
Dose 2 — Moderna
2021-03-15
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 7, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-19
Survey response — day 35, dose 2
MedDRA: Abdominal discomfort — Feeling: Good

Free text: Gastrointestinal problems

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-15
Survey response — 6 months, dose 2
MedDRA: Back pain, Myalgia — Feeling: Fair

Free text: Muscle pains in lower abdomen and back

MedDRA releases: 2024-11 · check-in free text available
2021-10-26
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling, Itching · Headache

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Headache

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · Site: Itching · Headache

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-02
Survey response — day 35, dose 3
MedDRA: Pruritus, Swelling face — Feeling: Good

Free text: Swelling in my face and body itching

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Survey response — day 42, dose 3
MedDRA: Arterial occlusive disease, Influenza virus test negative, Medical counselling, Nasopharyngitis, Rash — Feeling: Fair

Free text: Cold rash and blocked artery I don't know if it came from the shot but I have it I have three call (b)(6) yeah we're negative flu was negative for strep to Caucasus negative negative

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
Survey response — 3 months, dose 3
MedDRA: Myalgia — Feeling: Fair

Free text: Muscle aches in arms and legs

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Survey response — 6 months, dose 3
MedDRA: Adverse reaction, COVID-19 — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Had Covid ! Looks like I have blood clots in my arms from the first booster shot

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-28
Call successful
Participant prefers to complete VAERS report online
2022-10-26
Survey response — 12 months, dose 3
MedDRA: Lower limb fracture, Osteoporosis — 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: Knee osteperosis , and fracture

MedDRA releases: 2024-11 · check-in free text available
2022-10-26
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-27
Call 1 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-15	Moderna
2	2021-03-15	Moderna
3	2021-10-26	Moderna	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 4 — day 14, dose 1

2021-03-01

Symptoms: Tired

Release 7 — day 35, dose 2

2021-04-19

Symptoms: Gastrointestinal problems

Release 9 — 6 months, dose 2

2021-09-15

Symptoms: Muscle pains in lower abdomen and back

Release 10 — day 35, dose 3

2021-12-02

Symptoms: Swelling in my face and body itching

Release 10 — day 42, dose 3

2021-12-09

Symptoms: Cold rash and blocked artery I don't know if it came from the shot but I have it I have three call (b)(6) yeah we're negative flu was negative for strep to Caucasus negative negative

redacted (b)(6)

Release 11 — 3 months, dose 3

2022-01-25

Symptoms: Muscle aches in arms and legs

Release 11 — 6 months, dose 3

2022-04-26

Symptoms: Had Covid ! Looks like I have blood clots in my arms from the first booster shot

Release 12 — 12 months, dose 3

2022-10-26

Symptoms: Knee osteperosis , and fracture

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
SD	Abdominal discomfort	✓	✓	✓
SD	Adverse reaction	·	·	✓
SD	Arterial occlusive disease	·	·	✓
SD	Back pain	·	·	✓
SD	COVID-19	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Influenza virus test negative	·	·	✓
SD	Lower limb fracture	·	·	✓
SD	Medical counselling	·	·	✓
SD	Myalgia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Osteoporosis	·	·	✓
SD	Pruritus	·	·	✓
SD	Rash	·	·	✓
SD	Swelling face	·	·	✓

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