3VP-26691-90767

4 vaccinations 28 coded responses 40 check-ins 26 free-text entries 8 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 959 / CA
Registered: 2021-02-28

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

2021-02-27
Dose 1 — Moderna
2021-02-28
Registered in v-safe
2021-02-28
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite, Nausea — Feeling: Good · Site: Pain, Redness, Swelling · Chills, Muscle or body aches, Fatigue or tiredness

Free text: Yesterday, I had nausea. I didn't feel like eating.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Abdominal pain

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-06
Survey response — day 7, dose 1
MedDRA: Oral herpes — Feeling: Good

Free text: Herpe on on mouth. Probably not related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-21
Survey response — day 21, dose 1
MedDRA: Headache — Feeling: Fair

Free text: Headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Dose 2 — Moderna
2021-03-24
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-25
Survey response — days 1–6 daily, dose 2
MedDRA: Nasal congestion — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Stuffy nose,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Breast pain, Lymph node pain, Oropharyngeal pain — Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Under my arm clear to the side of my breast is sore. Lymph nodes under my arm are sore especially to touch. I had a sore throat yesterday. I forgot to report that.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site erythema, Injection site swelling, Oral herpes — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Be unable to do your normal daily activities

Free text: Herpes on my mouth. It happened with the first shot too. Red swollen patch on the front side of the arm where I got the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Oral herpes — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Cold sore on my mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-04-08
Survey response — day 14, dose 2
MedDRA: Oropharyngeal pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Sore throat for 3 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — day 21, dose 2
MedDRA: Headache, Oral herpes — 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: Cold sores and headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-24
Survey response — day 28, dose 2
MedDRA: Cough — Feeling: Good

Free text: Cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-05
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-23
Survey response — 3 months, dose 2
MedDRA: Condition aggravated, Fatigue, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Reocurring Herpes, tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-23
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-29
Call 1 — Left Voicemail
2021-06-29
Call 1 — Left Voicemail
2021-10-30
Dose 3 — Moderna
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Breast pain, Cough, Ear discomfort, Neck pain, Oropharyngeal pain, Rhinorrhoea, Throat clearing — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Neck pain on left side, sore breast on left side, sore throat on right side, runny nose, need to keep clearing throat, slight cough, ear feels funny on right side

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Feeding disorder, Mobility decreased, Night sweats, Oropharyngeal pain — Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Free text: I have had night sweats since getting the shot 4 days ago. Under my arm hurts. I had a bad sore throat until today, so for 3 days. The first 24 hours were rough. I couldn't eat. Needed to stay in bed.

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Breast pain — Feeling: Good · Site: Pain · Muscle or body aches

Free text: A little pain under my arm and on the side of my breast.

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — day 7, dose 3
MedDRA: Back pain — Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Free text: Back aches

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Survey response — day 14, dose 3
MedDRA: Back pain, Injection site pain, Oral herpes — Feeling: Fair

Free text: My arm still hurts where I got the shot. I did get a cold sore again. My back hurts too.

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Survey response — day 21, dose 3
MedDRA: Lymph node pain, Pain in extremity — Feeling: Good

Free text: I am ok now, but my arm was sore for 18 days after the shot. On the 15th through the 18th days, my lymph nodes on my jawline were really sore.

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Survey response — day 28, dose 3
MedDRA: Flank pain, Oral herpes — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: My whole uper lip has herpes. · Healthcare visit (other): I have valcyclovir pills and a topical from the doctor that I am using. In my waist area, around my back, is super sore.

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-30
Call 2 — Left Voicemail
2022-01-29
Survey response — 3 months, dose 3
MedDRA: Back pain, Pain, Telemedicine — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Left side of back and torso hurt. Some days very painful to move · Healthcare visit (other): Family doctor via computer visit. She saod if it continues that she needs to see me.

MedDRA releases: 2024-11 · check-in free text available
2022-01-29
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-02
Call successful
Participant prefers to complete VAERS report online
2022-10-08
Dose 4 — Moderna
2022-10-09
Survey response — days 1–6 daily, dose 4
MedDRA: Oral herpes, Pain, Vaccine positive rechallenge — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Cold sore-Herpes. This is my 4th shot and each time I get Herpes on my mouth. · Healthcare visit (other): I took Tylenol for the aches. I have Zovirax cream already, or I would have called a doctor

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Report sent to call center — days 1–6 daily, dose 4
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)
2022-10-10
Survey response — days 1–6 daily, dose 4
MedDRA: Rhinorrhoea, Self-medication — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Yesterday-runny nose, watery snot, dripping when I bend over, all symptoms are manageable with Tylenol and Valacyclovir

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Call 2 — Left Voicemail
2022-10-10
Call 2 — Left Voicemail
2022-10-10
Call 1 — Left Voicemail
2022-10-10
Call 1 — Left Voicemail
2022-10-14
Survey response — days 1–6 daily, dose 4
MedDRA: Oropharyngeal pain, Pain, Self-medication — Feeling: Good

Free text: Yesterday, I had a sore throat and was achey. I could do my job and The day before I .as achey all over!! Took Tylenol. I couldn't do my work and normal activities on Wednesday without Tylenol.I forgot do do my checkin yesterday and the day before.

MedDRA releases: 2024-11 · check-in free text available
2022-10-15
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-10-22
Survey response — day 14, dose 4
MedDRA: Diarrhoea — Feeling: Good

Free text: I had diarrhea three days this week; Monday, Tuesday, and Wednesday. I didn't feel good.

MedDRA releases: 2024-11 · check-in free text available
2022-10-29
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-05
Survey response — day 28, dose 4
MedDRA: Ear discomfort, Headache, Nasal congestion, Oropharyngeal pain, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: I had a flu shot last Saturday. During the week, I had a sore throat, Monday-Thursday. My ear felt stuffy yesterday, Friday, and I felt like I had a fever and a headache. My nose was a little stuffy this morning, Saturday. I feel fine right now.

MedDRA releases: 2024-11 · check-in free text available
2022-11-17
Survey response — day 35, dose 4
MedDRA: Oral herpes, Rash, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Cold sore. Crusty rash at hairline on the back of my neck. Never had this before. · Healthcare visit (other): I have medicine. Valcyclovir pulls and acyclovir topical

MedDRA releases: 2024-11 · check-in free text available
2022-11-17
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-18
Call successful
Not applicable - Accidental Reporting
2022-11-18
Call successful
Not applicable - Accidental Reporting
2022-11-18
Call successful
Not applicable - Accidental Reporting
2022-11-18
Call successful
Participant prefers to complete VAERS report online
2022-11-18
Call successful
Participant prefers to complete VAERS report online
2022-11-24
Survey response — day 42, dose 4
MedDRA: Oral herpes, Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Cold sore. Rash on neck at hairline and above.

MedDRA releases: 2024-11 · check-in free text available
2022-11-24
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-25
Call 2 — Left Voicemail
2023-01-07
Survey response — 3 months, dose 4
MedDRA: Chills, Fatigue, Gastrointestinal disorder, Headache, Nasal congestion, Rash, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-04-08
Survey response — 6 months, dose 4
MedDRA: Ulcer, Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-04-08
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-04-11
Call 1 — Left Voicemail
2023-04-11
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-27	Moderna
2	2021-03-24	Moderna
3	2021-10-30	Moderna	No
4	2022-10-08	Moderna	No

Call center

8 call center cases

6 successful · 2 unsuccessful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-28

Systemic reaction (other): Yesterday, I had nausea. I didn't feel like eating.

Release 5 — day 7, dose 1

2021-03-06

Systemic reaction (other): Herpe on on mouth. Probably not related.

Release 6 — day 21, dose 1

2021-03-21

Symptoms: Headaches

Release 6 — days 1–6 daily, dose 2

2021-03-25

Systemic reaction (other): Stuffy nose,

2021-03-26

Systemic reaction (other): Under my arm clear to the side of my breast is sore. Lymph nodes under my arm are sore especially to touch. I had a sore throat yesterday. I forgot to report that.

2021-03-27

Systemic reaction (other): Herpes on my mouth. It happened with the first shot too. Red swollen patch on the front side of the arm where I got the shot.

2021-03-29

Systemic reaction (other): Cold sore on my mouth

Release 7 — day 14, dose 2

2021-04-08

Symptoms: Sore throat for 3 days.

Release 7 — day 21, dose 2

2021-04-14

Symptoms: Cold sores and headache

Release 7 — day 28, dose 2

2021-04-24

Symptoms: Cough

Release 9 — 3 months, dose 2

2021-06-23

Symptoms: Reocurring Herpes, tired

Release 10 — days 1–6 daily, dose 3

2021-11-01

Systemic reaction (other): Neck pain on left side, sore breast on left side, sore throat on right side, runny nose, need to keep clearing throat, slight cough, ear feels funny on right side

2021-11-03

Systemic reaction (other): I have had night sweats since getting the shot 4 days ago. Under my arm hurts. I had a bad sore throat until today, so for 3 days. The first 24 hours were rough. I couldn't eat. Needed to stay in bed.

2021-11-04

Systemic reaction (other): A little pain under my arm and on the side of my breast.

Release 10 — day 7, dose 3

2021-11-06

Systemic reaction (other): Back aches

Release 10 — day 14, dose 3

2021-11-13

Symptoms: My arm still hurts where I got the shot. I did get a cold sore again. My back hurts too.

Release 10 — day 21, dose 3

2021-11-22

Symptoms: I am ok now, but my arm was sore for 18 days after the shot. On the 15th through the 18th days, my lymph nodes on my jawline were really sore.

Release 10 — day 28, dose 3

2021-11-27

Symptoms: My whole uper lip has herpes.

Healthcare visit (other): I have valcyclovir pills and a topical from the doctor that I am using. In my waist area, around my back, is super sore.

Release 11 — 3 months, dose 3

2022-01-29

Symptoms: Left side of back and torso hurt. Some days very painful to move

Healthcare visit (other): Family doctor via computer visit. She saod if it continues that she needs to see me.

Release 12 — days 1–6 daily, dose 4

2022-10-09

Systemic reaction (other): Cold sore-Herpes. This is my 4th shot and each time I get Herpes on my mouth.

Healthcare visit (other): I took Tylenol for the aches. I have Zovirax cream already, or I would have called a doctor

2022-10-10

Systemic reaction (other): Yesterday-runny nose, watery snot, dripping when I bend over, all symptoms are manageable with Tylenol and Valacyclovir

2022-10-14

Systemic reaction (other): Yesterday, I had a sore throat and was achey. I could do my job and The day before I .as achey all over!! Took Tylenol. I couldn't do my work and normal activities on Wednesday without Tylenol.I forgot do do my checkin yesterday and the day before. cut off by CDC

Release 12 — day 14, dose 4

2022-10-22

Symptoms: I had diarrhea three days this week; Monday, Tuesday, and Wednesday. I didn't feel good.

Release 12 — day 28, dose 4

2022-11-05

Symptoms: I had a flu shot last Saturday. During the week, I had a sore throat, Monday-Thursday. My ear felt stuffy yesterday, Friday, and I felt like I had a fever and a headache. My nose was a little stuffy this morning, Saturday. I feel fine right now.

Release 12 — day 35, dose 4

2022-11-17

Symptoms: Cold sore. Crusty rash at hairline on the back of my neck. Never had this before.

Healthcare visit (other): I have medicine. Valcyclovir pulls and acyclovir topical

Release 12 — day 42, dose 4

2022-11-24

Symptoms: Cold sore. Rash on neck at hairline and above.

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	Flank pain	·	·	✓
HCVO	Pain	·	·	✓
HCVO	Telemedicine	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Back pain	·	·	✓
SD	Chills	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Ear discomfort	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	✓	✓	✓
SD	Injection site pain	·	·	✓
SD	Lymph node pain	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Oral herpes	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Ulcer	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Axillary pain	✓	✓	✓
SRO	Back pain	·	·	✓
SRO	Breast pain	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Ear discomfort	·	·	✓
SRO	Feeding disorder	·	·	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Lymph node pain	✓	✓	✓
SRO	Mobility decreased	·	·	✓
SRO	Nasal congestion	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Neck pain	·	·	✓
SRO	Night sweats	·	·	✓
SRO	Oral herpes	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain	·	·	✓
SRO	Rhinorrhoea	·	·	✓
SRO	Self-medication	·	·	✓
SRO	Throat clearing	·	·	✓
SRO	Vaccine positive rechallenge	·	·	✓

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