4JB-19307-60836

3 vaccinations 15 coded responses 30 check-ins 15 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 992 / WA
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

2021-01-22
Dose 1 — Moderna
2021-01-28
Registered in v-safe
2021-01-30
Health check-in — day 7, dose 1
Feeling: Fair · Site: Redness, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-02-05
Survey response — day 14, dose 1
MedDRA: Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bacterial bowel infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-12
Survey response — day 21, dose 1
MedDRA: Bacterial infection, Gastrointestinal infection — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bacterial bowel infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-16
Dose 2 — Moderna
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Pain in extremity, Rash — Feeling: Fair · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Free text: The rash is on the front of my arm opposite of the infection site on the back of my arm. My first shot was in the other arm both arms and shoulders are aching and tender to the touch

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain, Redness · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain, Redness · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Survey response — day 7, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Mo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — day 14, dose 2
MedDRA: Diarrhoea, Frequent bowel movements, Mucous stools — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bowel issues. Frequent loose stools with lots of Mucus.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-09
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-30
Survey response — day 42, dose 2
MedDRA: Dyspnoea, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Shortness of breath · Healthcare visit (other): Chest X-ray today...no results yet

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-18
Survey response — 3 months, dose 2
MedDRA: Gastrointestinal disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Digestive issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-11
Call successful
Does not wish to fill out VAERS report
2021-08-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-26
Survey response — day 0, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Night sweats — Feeling: Good · Site: Pain

Free text: Night swears

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Limb mass — Feeling: Good · Site: Pain

Free text: A lump on my leg. Blood clot??? Will watch it

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-26
Survey response — 6 months, dose 3
MedDRA: Macular degeneration — Feeling: Good · 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: Macular degeneration in my left eye

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
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)
2022-05-03
Call 1 — Left Voicemail
2022-10-26
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-16	Moderna
3	2021-10-26	Moderna	No

Call center

6 call center cases

5 successful · 1 unsuccessful

See the call center timeline

Free text

Release 3 — day 14, dose 1

2021-02-05

Symptoms: Bacterial bowel infection

Release 4 — day 21, dose 1

2021-02-12

Symptoms: Bacterial bowel infection

Release 4 — days 1–6 daily, dose 2

2021-02-19

Systemic reaction (other): The rash is on the front of my arm opposite of the infection site on the back of my arm. My first shot was in the other arm both arms and shoulders are aching and tender to the touch

2021-02-20

Systemic reaction (other): No

2021-02-21

Systemic reaction (other): No

2021-02-22

Systemic reaction (other): No

Release 4 — day 7, dose 2

2021-02-23

Systemic reaction (other): Mo

Release 4 — day 14, dose 2

2021-03-02

Symptoms: Bowel issues. Frequent loose stools with lots of Mucus.

Release 6 — day 42, dose 2

2021-03-30

Symptoms: Shortness of breath

Healthcare visit (other): Chest X-ray today...no results yet

Release 8 — 3 months, dose 2

2021-05-18

Symptoms: Digestive issues

Release 10 — day 0, dose 3

2021-10-26

Systemic reaction (other): No

Release 10 — days 1–6 daily, dose 3

2021-10-27

Systemic reaction (other): No

2021-10-28

Systemic reaction (other): Night swears

2021-10-29

Systemic reaction (other): A lump on my leg. Blood clot??? Will watch it

Release 11 — 6 months, dose 3

2022-04-26

Symptoms: Macular degeneration in my left eye

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	Bacterial infection	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Frequent bowel movements	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Gastrointestinal infection	✓	✓	✓
SD	Macular degeneration	·	·	✓
SD	Mucous stools	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Limb mass	·	·	✓
SRO	Night sweats	·	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Rash	✓	✓	✓

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