3S3-30617-27550

4 vaccinations 16 coded responses 45 check-ins 15 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 402 / KY
Registered: 2021-02-02

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

2021-01-17
Dose 1 — Moderna
2021-02-02
Registered in v-safe
2021-02-02
Survey response — day 14, dose 1
MedDRA: Chills, Malaise, Oral discomfort, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Burning mouth onset1/25/2021Thiis my first check in.First 3 days I had a very sore arm, slight chills, and malaise. No fever. Did not read handout therefore did not know about this App.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-07
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-14
Dose 2 — Moderna
2021-02-14
Survey response — day 0, dose 2
MedDRA: Feeling cold — Feeling: Good · Site: Itching · Chills

Free text: Feel cold. No chills, just cold at this time. Coli ankle, legs and knees

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Abnormal dreams, Hot flush — Feeling: Fair · Site: Swelling, Itching · Chills, Headache

Free text: Wierd dreams noted on first night after vaccines. Occur after both dreams. In creased hot flashes at night while in bed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Joint pains

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Dry skin, Eyelids pruritus, Pruritus — Feeling: Good · Site: Swelling, Itching

Free text: Itchy dry skin on extremities. Lots of eyelid itching that I forgot to mention on previous days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-21
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-28
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-07
Survey response — day 21, dose 2
MedDRA: Abdominal pain upper, Back pain, Candida infection, Office visit, Oral discomfort, Pain, Reaction to previous exposure to any vaccine — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Severe Thrush day 5 of first dose of vaccine. After 2nd vaccine(2ndweekfollowing) developed right upper epigastric pain radiating to back. All resulting from case of burning mouth and thrush. Mentioned Thrush/burning mouth with first report filed. · Healthcare visit (other): PCand ENT

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-21
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-30
Survey response — day 42, dose 2
MedDRA: Burning mouth syndrome, Ear, nose and throat examination, Gastrointestinal tract irritation, Livedo reticularis, Office visit, Oral discomfort, Palpitations, Specialist consultation — Feeling: Fair · 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: Symptoms: Mottled foot and leg after hard heart palpitations after first injection.Severe burning mouth syndrome. · Healthcare visit (other): ENT, GI, Cardiologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-16
Call successful
Participant prefers to complete VAERS report online
2021-06-16
Call successful
Participant prefers to complete VAERS report online
2021-06-16
Call successful
Participant prefers to complete VAERS report online
2021-08-16
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-24
Dose 3 — Moderna
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Abdominal pain

Adult check-in
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site mass, Injection site rash — Feeling: Good · Site: Redness, Swelling, Itching · Joint pains, Rash, not including the immediate area around the injection site

Free text: Rash and small lump3inches below injection site

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good · Site: Redness, Swelling, Itching · Headache, Abdominal pain, Rash, not including the immediate area around the injection site

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · Chills

Adult check-in
2021-10-31
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-07
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
2021-11-21
Survey response — day 28, dose 3
MedDRA: Joint stiffness, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stiff joints, aching muscles

MedDRA releases: 2024-11 · check-in free text available
2021-11-30
Survey response — day 35, dose 3
MedDRA: Arthritis, Joint stiffness, Musculoskeletal stiffness, Pre-existing disease, Vaccine positive rechallenge — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stiff muscles and joints.Arthritis symptoms increased after alll 3 injections.

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-23
Survey response — 3 months, dose 3
MedDRA: Headache, Oropharyngeal pain — Feeling: Good

Free text: Mild sore throat and a dull headache 1 week ago.

MedDRA releases: 2024-11 · check-in free text available
2022-04-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-18
Dose 4 — Moderna
2022-05-18
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-05-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains, Abdominal pain

Adult check-in
2022-05-22
Survey response — days 1–6 daily, dose 4
MedDRA: Arthralgia, Joint stiffness — Feeling: Good · Site: Swelling · Joint pains

Free text: Joint tends to touch ,Joint stiffness

MedDRA releases: 2024-11 · check-in free text available
2022-05-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-24
Survey response — days 1–6 daily, dose 4
MedDRA: Cough, Throat irritation — Feeling: Fair · Headache

Free text: Cough, scratchy throat

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Health check-in — day 7, dose 4
Feeling: Good · Chills

Adult check-in
2022-06-01
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-08
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-15
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-22
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-29
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-17
Survey response — 3 months, dose 4
MedDRA: COVID-19 — Feeling: Good · 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: Had Covid

MedDRA releases: 2024-11 · check-in free text available
2022-08-17
Report sent to call center — 3 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-08-18
Call 1 — Left Voicemail
2022-08-18
Call 1 — Left Voicemail
2022-08-18
Call 1 — Left Voicemail
2022-08-18
Call 1 — Left Voicemail
2022-08-18
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-16
Survey response — 6 months, dose 4
MedDRA: Arthralgia, Myalgia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Muscle and joint pain

MedDRA releases: 2024-11 · check-in free text available
2022-11-16
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-17
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-05-19
Survey response — 12 months, dose 4
MedDRA: Arthralgia, Arthritis, Back pain, Mobility decreased, Myalgia, Pain in extremity, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-05-19
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-05-22
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-17	Moderna
2	2021-02-14	Moderna
3	2021-10-24	Moderna	No
4	2022-05-18	Moderna	No

Call center

6 call center cases

5 successful · 1 unsuccessful

3 waits over 3 months for a first call

See the call center timeline

Free text

Release 3 — day 14, dose 1

2021-02-02

Symptoms: Burning mouth onset1/25/2021Thiis my first check in.First 3 days I had a very sore arm, slight chills, and malaise. No fever. Did not read handout therefore did not know about this App.

Release 4 — day 0, dose 2

2021-02-14

Systemic reaction (other): Feel cold. No chills, just cold at this time. Coli ankle, legs and knees

Release 4 — days 1–6 daily, dose 2

2021-02-15

Systemic reaction (other): Wierd dreams noted on first night after vaccines. Occur after both dreams. In creased hot flashes at night while in bed.

2021-02-19

Systemic reaction (other): Itchy dry skin on extremities. Lots of eyelid itching that I forgot to mention on previous days.

Release 5 — day 21, dose 2

2021-03-07

Symptoms: Severe Thrush day 5 of first dose of vaccine. After 2nd vaccine(2ndweekfollowing) developed right upper epigastric pain radiating to back. All resulting from case of burning mouth and thrush. Mentioned Thrush/burning mouth with first report filed.

Healthcare visit (other): PCand ENT

Release 6 — day 42, dose 2

2021-03-30

Symptoms: Mottled foot and leg after hard heart palpitations after first injection.Severe burning mouth syndrome.

Healthcare visit (other): ENT, GI, Cardiologist.

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): Rash and small lump3inches below injection site

2021-10-28

Systemic reaction (other): No

Release 10 — day 28, dose 3

2021-11-21

Symptoms: Stiff joints, aching muscles

Release 10 — day 35, dose 3

2021-11-30

Symptoms: Stiff muscles and joints.Arthritis symptoms increased after alll 3 injections.

Release 11 — 3 months, dose 3

2022-01-23

Symptoms: Mild sore throat and a dull headache 1 week ago.

Release 11 — days 1–6 daily, dose 4

2022-05-22

Systemic reaction (other): Joint tends to touch ,Joint stiffness

2022-05-24

Systemic reaction (other): Cough, scratchy throat

Release 12 — 3 months, dose 4

2022-08-17

Symptoms: Had Covid

Release 12 — 6 months, dose 4

2022-11-16

Symptoms: Muscle and joint pain

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	Ear, nose and throat examination	○	✓	○
HCVO	Gastrointestinal tract irritation	○	✓	○
HCVO	Office visit	✓	✓	✓
HCVO	Specialist consultation	○	✓	○
SD	Abdominal pain upper	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Arthritis	·	·	✓
SD	Back pain	✓	✓	✓
SD	Burning mouth syndrome	✓	·	✓
SD	Candida infection	✓	✓	✓
SD	Chills	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Headache	·	·	✓
SD	Joint stiffness	·	·	✓
SD	Livedo reticularis	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Mobility decreased	·	·	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Myalgia	·	·	✓
SD	Oral discomfort	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Palpitations	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Reaction to previous exposure to any vaccine	✓	✓	✓
SD	Vaccine positive rechallenge	·	·	✓
SRO	Abnormal dreams	✓	✓	✓
SRO	Arthralgia	·	·	✓
SRO	Cough	·	·	✓
SRO	Dry skin	✓	✓	✓
SRO	Eyelids pruritus	✓	✓	✓
SRO	Feeling cold	✓	✓	✓
SRO	Hot flush	✓	✓	✓
SRO	Injection site mass	·	·	✓
SRO	Injection site rash	·	·	✓
SRO	Joint stiffness	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Pruritus	✓	✓	✓
SRO	Throat irritation	·	·	✓

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