48B-19482-13853

3 vaccinations 7 coded responses 27 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 902 / CA
Registered: 2021-03-04

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

2021-02-04
Dose 1 — Moderna
2021-03-02
Dose 2 — Moderna
2021-03-04
Registered in v-safe
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Tenderness — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Tenderness in underarm area in same arm as vaccine administered

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Tenderness — Feeling: Good · Site: Pain, Swelling · Headache, Muscle or body aches

Free text: Continuing tenderness under left armpit (lymph nodes swelling?)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Muscle or body aches

Adult check-in
2021-03-09
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Adult check-in
2021-03-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-30
Survey response — day 28, dose 2
MedDRA: Axillary pain, Swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: Soreness under my left arm (vaccinated arm) has returned although swelling is gone since the second shot on March 2

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-13
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-31
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Headache — Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Headache daily since booster shot

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — day 7, dose 3
Feeling: Good · Site: Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-11-10
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Survey response — 3 months, dose 3
MedDRA: COVID-19, Pyrexia, Rash, Rash erythematous — Feeling: Good

Free text: Red dotted rash across stomach - perhaps caused by my high fever during Covid

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Survey response — 6 months, dose 3
MedDRA: Cough, Headache, Respiratory tract congestion — Feeling: Poor · 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: Bronchial persistent cough, congestion, headavhe

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Report sent to call center — 6 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)
2022-04-28
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-27
Survey response — 12 months, dose 3
MedDRA: Blood potassium increased, Blood pressure increased, Cardiac disorder, Supraventricular extrasystoles, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Elevated potassium Heart issues including supraventricular ectopy incidents; elevated blood pressure incidents · Healthcare visit (other): Doctor's appointment scheduled for 11/1/22

MedDRA releases: 2024-11 · check-in free text available
2022-10-27
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-28
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-02	Moderna
3	2021-10-27	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-04

Systemic reaction (other): Tenderness in underarm area in same arm as vaccine administered

2021-03-06

Systemic reaction (other): Continuing tenderness under left armpit (lymph nodes swelling?)

Release 6 — day 28, dose 2

2021-03-30

Symptoms: Soreness under my left arm (vaccinated arm) has returned although swelling is gone since the second shot on March 2

Release 10 — days 1–6 daily, dose 3

2021-11-02

Systemic reaction (other): Headache daily since booster shot

Release 11 — 3 months, dose 3

2022-01-27

Symptoms: Red dotted rash across stomach - perhaps caused by my high fever during Covid

Release 11 — 6 months, dose 3

2022-04-27

Symptoms: Bronchial persistent cough, congestion, headavhe

Release 12 — 12 months, dose 3

2022-10-27

Symptoms: Elevated potassium Heart issues including supraventricular ectopy incidents; elevated blood pressure incidents

Healthcare visit (other): Doctor's appointment scheduled for 11/1/22

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	Unevaluable event	·	·	✓
SD	Axillary pain	✓	✓	✓
SD	Blood potassium increased	·	·	✓
SD	Blood pressure increased	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Headache	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	Rash erythematous	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Supraventricular extrasystoles	·	·	✓
SD	Swelling	✓	✓	✓
SRO	Headache	·	·	✓
SRO	Tenderness	✓	✓	✓

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