4CH-20001-83067

4 vaccinations 6 coded responses 16 check-ins 6 free-text entries 5 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 060 / CT
Registered: 2021-01-28

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

2020-12-29
Dose 1 — Moderna
2021-01-26
Dose 2 — Moderna
2021-01-28
Registered in v-safe
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · None

Adult check-in
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Dyspepsia — Feeling: Fair · Site: Pain, Redness · Nausea

Free text: Indigestion, low appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Itching · Headache, Muscle or body aches

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Abdominal pain

Adult check-in
2021-02-02
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-02-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-23
Survey response — day 28, dose 2
MedDRA: Hospitalisation — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: A likely syncopal episode that led to a fall on stairs resulted in a fractured left wrist. I did not recall the fall when I regained consciousness at the bottom of the stairs. Went to the emergency room at hospital for care.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Report sent to call center — day 28, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — 3 months, dose 2
Feeling: Poor

Adult check-in
2021-07-27
Survey response — 6 months, dose 2
MedDRA: Arthritis, Fall, Herpes zoster, Musculoskeletal pain, Physiotherapy, Pre-existing disease, Pruritus, Rotator cuff repair, Surgery — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Continued treatment, rotator cuff surgery, PT, after accidental fall on Feb 18. Shingles that started 3-9-21 have not fully resolved, but minimal itching. New, increasing arthritis pain in butt, nocturnal may be from gluten ingested accidentally. · Healthcare visit (other): Outpatient surgery

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-27
Report sent to call center — 6 months, dose 2
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)
2021-07-28
Call 1 — Left Voicemail
2021-11-18
Dose 3 — Moderna
2021-11-18
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2021-11-18
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-01-26
Survey response — 12 months, dose 2
MedDRA: COVID-19, Cough, Dyspnoea, Fall, Gait disturbance, Office visit, SARS-CoV-2 test positive, Sinus congestion — Feeling: Good · 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: Tripped, fell at home, late October; No injuries. Contracted Covid-19 infection, symptoms 1-4-22. Home test kit positive, 1-6-22. Breathing difficulty, coughing & sinus congestion since 1-14-22. PCP visit 1-20-22, asthma meds, nebulizer ongoing. · Healthcare visit (other): Able to see PCP in outpatient ofc.

MedDRA releases: 2024-11 · check-in free text available
2022-01-26
Report sent to call center — 12 months, dose 2
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)
2022-01-28
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-09-04
Dose 4 — Moderna
Co-administered: Flu
2022-10-12
Survey response — day 35, dose 4
MedDRA: Arthralgia, Chest discomfort, Joint swelling, Office visit, Synovial cyst — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Baker's Cyst diagnosed after having right knee pain and fullness posteriorly. Early morning awakening with respiratory tightness that requires several puffs on Albuterol inhaler. · Healthcare visit (other): The problems were mentioned at a scheduled visit with my new primary care physician.

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-13
Call 1 — Could Not Reach Participant
2022-10-13
Callback requested for
02:30PM ET
2022-12-04
Survey response — 3 months, dose 4
MedDRA: Musculoskeletal pain, Pain in extremity, Piriformis syndrome, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Pryaformas syndrome (severe pain in left butt going down leg) · Healthcare visit (other): Unable to be seen by my doctor until February, so haven't seen PCP yet.

MedDRA releases: 2024-11 · check-in free text available
2022-12-04
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

1 call case(s)
2022-12-05
Call 2 — Left Voicemail
2022-12-05
Call 1 — Left Voicemail
2022-12-07
Call 2 — Requested Callback
2022-12-08
Call 3 — Requested Callback
2022-12-08
Call 3 — Requested Callback
2022-12-13
Callback requested for
03:00PM ET
2022-12-14
Call X — Left Voicemail
2022-12-14
Call X — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-26	Moderna
3	2021-11-18	Moderna	No
4	2022-09-04	Moderna	Flu

Call center

5 call center cases

3 successful · 2 unsuccessful

VAERS report filed, before or during a call: 2

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 2

2021-01-29

Systemic reaction (other): Indigestion, low appetite

Release 4 — day 28, dose 2

2021-02-23

Symptoms: A likely syncopal episode that led to a fall on stairs resulted in a fractured left wrist. I did not recall the fall when I regained consciousness at the bottom of the stairs. Went to the emergency room at hospital for care.

Release 9 — 6 months, dose 2

2021-07-27

Symptoms: Continued treatment, rotator cuff surgery, PT, after accidental fall on Feb 18. Shingles that started 3-9-21 have not fully resolved, but minimal itching. New, increasing arthritis pain in butt, nocturnal may be from gluten ingested accidentally.

Healthcare visit (other): Outpatient surgery

Release 11 — 12 months, dose 2

2022-01-26

Symptoms: Tripped, fell at home, late October; No injuries. Contracted Covid-19 infection, symptoms 1-4-22. Home test kit positive, 1-6-22. Breathing difficulty, coughing & sinus congestion since 1-14-22. PCP visit 1-20-22, asthma meds, nebulizer ongoing.

Healthcare visit (other): Able to see PCP in outpatient ofc.

Release 12 — day 35, dose 4

2022-10-12

Symptoms: Baker's Cyst diagnosed after having right knee pain and fullness posteriorly. Early morning awakening with respiratory tightness that requires several puffs on Albuterol inhaler.

Healthcare visit (other): The problems were mentioned at a scheduled visit with my new primary care physician.

Release 12 — 3 months, dose 4

2022-12-04

Symptoms: Pryaformas syndrome (severe pain in left butt going down leg)

Healthcare visit (other): Unable to be seen by my doctor until February, so haven't seen PCP yet.

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	Surgery	✓	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Arthritis	✓	·	✓
SD	Chest discomfort	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fall	✓	·	✓
SD	Gait disturbance	·	·	✓
SD	Herpes zoster	✓	·	✓
SD	Hospitalisation	✓	✓	✓
SD	Joint swelling	·	·	✓
SD	Musculoskeletal pain	✓	·	✓
SD	Office visit	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Physiotherapy	✓	·	✓
SD	Piriformis syndrome	·	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Pruritus	✓	·	✓
SD	Rotator cuff repair	✓	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Synovial cyst	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dyspepsia	✓	✓	✓

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