45Q-28541-72391

4 vaccinations 14 coded responses 29 check-ins 14 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 394 / MS
Registered: 2021-01-18

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

2021-01-15
Dose 1 — Moderna
2021-01-18
Registered in v-safe
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Facial pain, Nodule — Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Fatigue or tiredness

Free text: Moderate pain right side of face with lump size of a quarter next to my ear. Pains when i open my mouth.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Pain, Rash, Swelling face, Tenderness — Feeling: Good · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Still have swelling on right side of face cose to ear and under temple. Tender, stinging sensation developed rash 2daywhen rub scross

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Facial discomfort, Swelling face — Feeling: Good · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches

Free text: Right side of face ztill has swelling and is sensitive to the touche

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — day 7, dose 1
MedDRA: Hyperaesthesia, Swelling face — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Diarrhea, Abdominal pain

Free text: Right dide of face swoolen and a sensitive to touch.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Survey response — day 21, dose 1
MedDRA: Diarrhoea, Fatigue, Palpitations, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Diarrhea increased in frequency and vomiting started last 3 days very vile. Heart beating out of my chest and big increase in fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Dose 2 — Moderna
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Chills, Joint pains, Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Mental impairment, Visual acuity reduced — Feeling: Good · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mental /visual recognition has slowed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — day 7, dose 2
MedDRA: Somnolence — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Falling asleep frequently

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — day 14, dose 2
MedDRA: Arthralgia, Dizziness, Feeling cold, Headache, Injection site discomfort, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Injection arm little discomfort after 2nd shot. However yesterday it increased considerably, from elbow to hand and fingers. Today quite painful can't carry anything with it. Headache much worse and i am dizzy and still cold.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-12
Survey response — day 28, dose 2
MedDRA: Ear pain, Facial pain, Headache, Pain in jaw — Feeling: Fair

Free text: The right side of my face, jaw, temple and ear are still painful.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-26
Survey response — day 42, dose 2
MedDRA: Asthenia, Lethargy, Peripheral swelling, Somnolence — Feeling: Fair

Free text: Swelling in legs and feet and weakness/lethargic / very sleepy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Survey response — 3 months, dose 2
MedDRA: Hypoaesthesia, Pain in extremity, Somnolence — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Sleepy all the time, sit down, unaware,fall asleep. Left arm gotten worse. Pain all the time and hand Xtreme pain sometimes fingers numb, no grip. Right hand also pain, some numbness and no grip.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-13
Survey response — 6 months, dose 2
MedDRA: Headache, Muscular weakness, Pre-existing disease, Sensitive skin, Sensory loss, Somnolence — Feeling: Fair · Be unable to do your normal daily activities

Free text: Left arm continues to get weaker and headaches have increased. Still no feeling in tips of fingers on left hand.Right side of face and temple area still very sensitive. Stay very sleepy.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Dose 3 — Moderna
2021-11-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-21
Survey response — 6 months, dose 3
MedDRA: Arthralgia, Fluid retention, Insomnia, Neck pain, Office visit, Pain in extremity — Feeling: Fair · 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: Symptoms: ALL joints ache. Hands worst. B Fluid retention down to toes, can't sleep but couple hours, ache in neck, thighs. Arms · Healthcare visit (other): PCP, heart, pulmonary,

MedDRA releases: 2024-11 · check-in free text available
2022-02-21
Report sent to call center — 6 months, dose 3
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)
2022-02-25
Call 1 — Left Voicemail
2022-03-11
Call successful
Participant prefers to complete VAERS report online
2022-04-14
Dose 4 — Moderna
2022-04-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-04-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-04-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-04-21
Health check-in — day 7, dose 4
Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-04-28
Health check-in — day 14, dose 4
Feeling: Good

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

Adult check-in
2022-05-12
Survey response — day 28, dose 4
MedDRA: Asthenia, Dizziness, Fatigue, Joint stiffness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stiffness in joints, fatigue worse, weakness and dizzy.

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-08-23	Moderna	No
4	2022-04-14	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-18

Systemic reaction (other): Moderate pain right side of face with lump size of a quarter next to my ear. Pains when i open my mouth.

2021-01-19

Systemic reaction (other): Still have swelling on right side of face cose to ear and under temple. Tender, stinging sensation developed rash 2daywhen rub scross

2021-01-21

Systemic reaction (other): Right side of face ztill has swelling and is sensitive to the touche

Release 2 — day 7, dose 1

2021-01-22

Systemic reaction (other): Right dide of face swoolen and a sensitive to touch.

Release 3 — day 21, dose 1

2021-02-05

Symptoms: Diarrhea increased in frequency and vomiting started last 3 days very vile. Heart beating out of my chest and big increase in fatigue.

Release 4 — days 1–6 daily, dose 2

2021-02-18

Systemic reaction (other): Mental /visual recognition has slowed

Release 4 — day 7, dose 2

2021-02-19

Systemic reaction (other): Falling asleep frequently

Release 4 — day 14, dose 2

2021-02-26

Symptoms: Injection arm little discomfort after 2nd shot. However yesterday it increased considerably, from elbow to hand and fingers. Today quite painful can't carry anything with it. Headache much worse and i am dizzy and still cold.

Release 5 — day 28, dose 2

2021-03-12

Symptoms: The right side of my face, jaw, temple and ear are still painful.

Release 6 — day 42, dose 2

2021-03-26

Symptoms: Swelling in legs and feet and weakness/lethargic / very sleepy

Release 8 — 3 months, dose 2

2021-05-16

Symptoms: Sleepy all the time, sit down, unaware,fall asleep. Left arm gotten worse. Pain all the time and hand Xtreme pain sometimes fingers numb, no grip. Right hand also pain, some numbness and no grip.

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: Left arm continues to get weaker and headaches have increased. Still no feeling in tips of fingers on left hand.Right side of face and temple area still very sensitive. Stay very sleepy.

Release 11 — 6 months, dose 3

2022-02-21

Symptoms: ALL joints ache. Hands worst. B Fluid retention down to toes, can't sleep but couple hours, ache in neck, thighs. Arms

Healthcare visit (other): PCP, heart, pulmonary,

Release 11 — day 28, dose 4

2022-05-12

Symptoms: Stiffness in joints, fatigue worse, weakness and dizzy.

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	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Facial pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling cold	✓	✓	✓
SD	Fluid retention	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Injection site discomfort	✓	✓	✓
SD	Insomnia	·	·	✓
SD	Joint stiffness	·	·	✓
SD	Lethargy	✓	✓	✓
SD	Muscular weakness	✓	·	✓
SD	Neck pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pain in jaw	✓	✓	✓
SD	Palpitations	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Sensitive skin	✓	·	✓
SD	Sensory loss	✓	·	✓
SD	Somnolence	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Facial discomfort	✓	✓	✓
SRO	Facial pain	✓	✓	✓
SRO	Hyperaesthesia	✓	✓	✓
SRO	Mental impairment	✓	✓	✓
SRO	Nodule	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Somnolence	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Tenderness	✓	✓	✓
SRO	Visual acuity reduced	✓	✓	✓

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