4HR-21917-36645
2 vaccinations
6 coded responses
19 check-ins
6 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 926 / CA
- Registered
- 2021-01-18
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-18
Registered in v-safe
-
2021-01-18
Dose 1 — Moderna
- 2021-01-18
-
2021-01-19
Survey response — days 1–6 daily, dose 1MedDRA: Blood pressure increased — Feeling: Fair · Site: Pain · HeadacheFree text: Elevated blood pressureMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-20
Survey response — days 1–6 daily, dose 1MedDRA: Back pain, Pain in extremity — Feeling: Fair · Site: Pain · Muscle or body achesFree text: Lower back pain and pain on the arm had vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-21
- 2021-01-22
- 2021-01-24
- 2021-01-25
- 2021-02-01
- 2021-02-08
-
2021-02-15
Dose 2 — Moderna
- 2021-02-15
- 2021-02-22
- 2021-03-01
- 2021-03-08
-
2021-03-15
Survey response — day 28, dose 2MedDRA: Headache — Feeling: Fair · Be unable to do your normal daily activitiesFree text: A lot of headaches that Ive never had before.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-22
Survey response — day 35, dose 2MedDRA: Insomnia, Pre-existing disease — Feeling: GoodFree text: I dont know its a good sign or not but Ive slept soundly after the second dose. I would say the mental health is the same. I had the insomnia for the last 7 years and always needed sleeping aid, however I did not need them after the secondMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-29
- 2021-05-17
-
2021-08-18
Survey response — 6 months, dose 2MedDRA: Muscle spasms — Feeling: FairFree text: More Leg crampsMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2022-02-16
Survey response — 12 months, dose 2MedDRA: Mobility decreased, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Cannot lift the arms much. Always in painMedDRA releases: 2024-11 · check-in free text available
-
2022-02-16
Report sent to call center — 12 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-02-17
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-18 | Moderna | |
| 2 | 2021-02-15 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Elevated blood pressure
Systemic reaction (other): Lower back pain and pain on the arm had vaccine
Release 5 — day 28, dose 2
Symptoms: A lot of headaches that Ive never had before.
Release 6 — day 35, dose 2
Symptoms: I dont know its a good sign or not but Ive slept soundly after the second dose. I would say the mental health is the same. I had the insomnia for the last 7 years and always needed sleeping aid, however I did not need them after the second
Release 9 — 6 months, dose 2
Symptoms: More Leg cramps
Release 11 — 12 months, dose 2
Symptoms: Cannot lift the arms much. Always in pain
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 |
|---|---|---|---|---|
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Insomnia | ✓ | ✓ | ✓ |
| SD | Mobility decreased | · | · | ✓ |
| SD | Muscle spasms | ✓ | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
| SRO | Blood pressure increased | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release