3Z3-10055-14211
5 vaccinations
14 coded responses
56 check-ins
13 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 852 / AZ
- Registered
- 2021-03-10
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-03-10
Registered in v-safe
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2021-03-10
Dose 1 — Moderna
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2021-03-10
Survey response — day 0, dose 1MedDRA: Pain in extremity — Feeling: FairFree text: Left arm sorenessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-11
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia, Musculoskeletal stiffness — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body achesFree text: Shoulder very sore and some stiffness down the armMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-12
Survey response — days 1–6 daily, dose 1MedDRA: Nonspecific reaction — Feeling: Fair · Muscle or body aches, Fatigue or tirednessFree text: Arm feels better todayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-24
- 2021-03-31
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2021-04-07
Dose 2 — Moderna
- 2021-04-07
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2021-04-08
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-04-09
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
- 2021-04-11
- 2021-04-12
- 2021-04-13
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-05-05
- 2021-05-12
- 2021-05-19
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2021-07-07
Survey response — 3 months, dose 2MedDRA: Office visit, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Disc disease and abnormal bone marrow · Healthcare visit (other): In office visits with my primary care provider, x-rays and MRI and physical therapyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-07-07
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-07-09
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2021-10-06
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2021-11-03
Dose 3 — Moderna
- 2022-04-07
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2022-05-15
Dose 4 — Moderna
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2022-05-15
Survey response — day 0, dose 4MedDRA: No adverse event — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2022-05-16
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
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2022-05-17
Survey response — days 1–6 daily, dose 4MedDRA: Asthenia — Feeling: Poor · Site: Swelling · Headache, Muscle or body achesFree text: Body is extremely weak. No energy.MedDRA releases: 2024-11 · check-in free text available
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2022-05-18
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tirednessFree text: NoneMedDRA releases: 2024-11 · check-in free text available
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2022-05-19
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Fair · Headache, NauseaFree text: NoneMedDRA releases: 2024-11 · check-in free text available
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2022-05-20
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Fair · Headache, NauseaFree text: NoneMedDRA releases: 2024-11 · check-in free text available
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2022-05-21
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Fair · Fatigue or tiredness, DiarrheaFree text: NoneMedDRA releases: 2024-11 · check-in free text available
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2022-05-22
Survey response — day 7, dose 4MedDRA: No adverse event — Feeling: Fair · Muscle or body aches, NauseaFree text: NoneMedDRA releases: 2024-11 · check-in free text available
- 2022-05-29
- 2022-06-05
- 2022-06-12
- 2022-06-19
- 2022-06-26
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2022-08-14
Survey response — 3 months, dose 4MedDRA: Arteriosclerosis coronary artery, Heart valve incompetence, Myalgia, Office visit, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Muscle pains in left arm where I have had all of my COVID shots and boosters. Also currently under a cardiologist who has discovered a calcium build up and small leak. Facing a CATH procedure September 29th. · Healthcare visit (other): Several heart testings completedMedDRA releases: 2024-11 · check-in free text available
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2022-08-14
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-08-15
Call successfulDoes not wish to fill out VAERS report
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2022-11-13
Survey response — 6 months, dose 4MedDRA: Chest pain, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Chest pains had a cath procedure end of September 2022. · Healthcare visit (other): Office visits several testsMedDRA releases: 2024-11 · check-in free text available
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2022-11-13
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
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2022-11-14
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-11-15
Dose 5 — Moderna
- 2022-11-15
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2022-11-16
Health check-in — days 1–6 daily, dose 5Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, DiarrheaAdult check-in
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2022-11-17
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Swelling · Headache, Fatigue or tirednessAdult check-in
- 2022-11-18
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2022-11-19
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-11-20
- 2022-11-21
- 2022-11-22
- 2022-11-29
- 2022-12-06
- 2022-12-13
- 2022-12-20
- 2022-12-27
- 2023-02-14
- 2023-05-16
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-10 | Moderna | |
| 2 | 2021-04-07 | Moderna | |
| 3 | 2021-11-03 | Moderna | No |
| 4 | 2022-05-15 | Moderna | No |
| 5 | 2022-11-15 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): Left arm soreness
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Shoulder very sore and some stiffness down the arm
Systemic reaction (other): Arm feels better today
Release 9 — 3 months, dose 2
Symptoms: Disc disease and abnormal bone marrow
Healthcare visit (other): In office visits with my primary care provider, x-rays and MRI and physical therapy
Release 11 — day 0, dose 4
Systemic reaction (other): No
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Body is extremely weak. No energy.
Systemic reaction (other): None
Systemic reaction (other): None
Systemic reaction (other): None
Systemic reaction (other): None
Release 11 — day 7, dose 4
Systemic reaction (other): None
Release 12 — 3 months, dose 4
Symptoms: Muscle pains in left arm where I have had all of my COVID shots and boosters. Also currently under a cardiologist who has discovered a calcium build up and small leak. Facing a CATH procedure September 29th.
Healthcare visit (other): Several heart testings completed
Release 12 — 6 months, dose 4
Symptoms: Chest pains had a cath procedure end of September 2022.
Healthcare visit (other): Office visits several tests
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 | Office visit | ✓ | ✓ | ✓ |
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Arteriosclerosis coronary artery | · | · | ✓ |
| SD | Back pain | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Heart valve incompetence | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Unevaluable event | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Asthenia | · | · | ✓ |
| SRO | Musculoskeletal stiffness | ✓ | ✓ | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Nonspecific reaction | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release