4QM-24703-35044

3 vaccinations 23 coded responses 38 check-ins 23 free-text entries 7 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 846 / UT
Registered: 2021-03-02

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-02
Registered in v-safe
2021-03-02
Dose 1 — Moderna
2021-03-02
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-09
Health check-in — day 7, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-30
Dose 2 — Moderna
2021-03-30
Survey response — day 0, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Swollen lymph node in right armpit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Free text: Swollen lymph node in right armpit (Right arm got the injection).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Muscular weakness — Feeling: Poor · Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Muscle weakness, extreme tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-04-13
Survey response — day 14, dose 2
MedDRA: Muscular weakness, Myasthenia gravis, Pre-existing disease — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Worsening of muscle weakness from myasthenia gravis (diagnosed in 2015), with difficulty standing up and walking.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Survey response — day 21, dose 2
MedDRA: Dysstasia, Fatigue, Gait disturbance, Muscular weakness, Myasthenia gravis, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Worsening of myasthenia gravis. Increased muscle weakness, fatigue, and difficulty standing up and walking. Thigh muscles have been the weakest.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — day 28, dose 2
MedDRA: Bedridden, Gait disturbance, Myasthenia gravis, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Worsening of myasthenia gravis (more days bed ridden or with difficulty walking) after having been in remission from Sept. 2019 to Mar. 2021.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — day 35, dose 2
MedDRA: Abdominal discomfort, Abdominal distension, Condition aggravated, Flatulence, Gastrointestinal motility disorder, Muscular weakness, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Mild worsening of muscle weakness from myasthenia gravis.Gastrointestinal upset - bloating, flatulence, dysmotility.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — day 42, dose 2
MedDRA: Abdominal distension, Flatulence — Feeling: Fair

Free text: Bloating and flatulence

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-30
Survey response — 3 months, dose 2
MedDRA: Sialoadenitis — 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 · Outpatient clinic or urgent care clinic visit

Free text: Salivary gland infection, treated effectively with antibiotics.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-30
Report sent to call center — 3 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)
2021-07-12
Call 1 — Left Voicemail
2021-08-18
Dose 3 — Moderna
2021-08-18
Survey response — day 0, dose 3
MedDRA: Muscular weakness, Pre-existing disease — Feeling: Poor · Site: Pain · Fatigue or tiredness

Free text: Mild muscle weakness related to myasthenia gravis

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-08-20
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Chest discomfort, Muscle tightness, Muscular weakness, Myasthenia gravis, Oedema peripheral, Pre-existing disease — Feeling: Poor · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness, Vomiting, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Swelling and pain in armpit near injection site. Tightness in chest & neck. Increased symptoms of muscle weakness from myasthenia gravis.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-21
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Chest discomfort, Hypersomnia, Joint stiffness, Lymphadenopathy, Muscle tightness, Oedema peripheral, Somnolence — Feeling: Poor · Site: Pain, Swelling · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Swollen glands in neck; tightness in chest, neck, and shoulder near injection site; swollen, painful armpit near injection site; Somnolence, sleeping excessively

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-22
Survey response — days 1–6 daily, dose 3
MedDRA: Asthenia, Dizziness, Dysstasia — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness, Abdominal pain

Free text: Lightheadedness and weakness when standing up or sitting up; I had to lie down again quickly.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Insomnia, Oedema peripheral — Feeling: Fair · Site: Swelling · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Swelling and pain in armpit near injection site. Insomnia.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-24
Survey response — days 1–6 daily, dose 3
MedDRA: Insomnia — Feeling: Good · Fatigue or tiredness, Abdominal pain · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Insomnia.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-24
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-25
Survey response — day 7, dose 3
MedDRA: Fatigue, Hypersomnia, Insomnia — Feeling: Fair · Fatigue or tiredness, Abdominal pain

Free text: Insomnia. I was incredibly tired and slept a lot for the 1st 3 full days after the shot, and have slept little or not at all for the next 4th-6th days

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-30
Call 1 — Left Voicemail
2021-09-03
Survey response — day 14, dose 3
MedDRA: Lymphadenitis, Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Lymph nodes in right armpit (arm of injection) still feel inflamed. I saw my neurologist on Sept. 1, 2021 to discuss severe reaction to 3rd dose of Moderna vaccine. I see my immunologist on Sept. 4, 2021. I have myasthenia gravis & immunodeficiency.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-03
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-07
Call 1 — Left Voicemail
2021-09-08
Survey response — day 21, dose 3
MedDRA: Decreased appetite, Insomnia, Pre-existing disease, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Worsening of rash on ny back. The rash has been on my back since 1st week of July 2021 prior to vaccine. Insomnia. Loss of appetite.

MedDRA releases: 2024-11 · check-in free text available
2021-09-08
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-10
Call 1 — Left Voicemail
2021-09-17
Survey response — day 28, dose 3
MedDRA: Blood immunoglobulin G decreased, Gene mutation, Office visit, Primary immunodeficiency syndrome, Rash, Selective IgG subclass deficiency — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Rash on back. I saw a dermatologist. I also saw my immunologist. She says I have a primary immunodeficiency due to a CARD 11 mutation + mild total IgG & IgG subclass deficiencies of unknown cause.

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-22
Survey response — day 35, dose 3
MedDRA: Rash, Rash erythematous, Rash pruritic — Feeling: Good

Free text: Rash of itchy red bumps over back continues.

MedDRA releases: 2024-11 · check-in free text available
2021-09-22
Call 1 — Left Voicemail
2021-09-29
Survey response — day 42, dose 3
MedDRA: Rash — Feeling: Good

Free text: Rash on back continues. It is not responding to prescriptions from dermatologist.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — 3 months, dose 3
MedDRA: Haemorrhagic ovarian cyst, Infertility female, Rash, Rash pruritic, Rhinorrhoea, Sialoadenitis, Unevaluable event, Urinary tract infection — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: Infection of left submandibular salivary gland with drainage into left side of nose. Urinary tract infection. Hemorrhagic ovarian cyst. Rash on back of itchy, painful red bumps finally cleared up after lasting months. Inability to get pregnant. · Healthcare visit (other): Hospital appointments scheduled

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — 3 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

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2021-11-22
Call 1 — Left Voicemail
2022-02-18
Survey response — 6 months, dose 3
MedDRA: Hypothyroidism, Rash, Rash erythematous, Sialoadenitis, Sinusitis — Feeling: Poor · 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: Rash of small red bumps over entire back, chest, back of neck, scalp, and chin since 11/25/2021. Salivary gland infection and sinus infection from 11/9 to 12/20/2021 and sinus infection from 1/13 to 2/8/2022. Hypothyroidism since 1/13/2022.

MedDRA releases: 2024-11 · check-in free text available
2022-02-18
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-25
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-02	Moderna
2	2021-03-30	Moderna
3	2021-08-18	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-30	Unsuccessful
2021-08-24	Unsuccessful
2021-09-03	Unsuccessful
2021-09-08	Unsuccessful
2021-09-17	Unsuccessful
2021-11-19	Unsuccessful
2022-02-18	Unsuccessful

Free text

Release 6 — day 0, dose 2

2021-03-30

Systemic reaction (other): Swollen lymph node in right armpit

Release 6 — days 1–6 daily, dose 2

2021-03-31

Systemic reaction (other): Swollen lymph node in right armpit (Right arm got the injection).

2021-04-05

Systemic reaction (other): Muscle weakness, extreme tiredness

Release 7 — day 14, dose 2

2021-04-13

Symptoms: Worsening of muscle weakness from myasthenia gravis (diagnosed in 2015), with difficulty standing up and walking.

Release 7 — day 21, dose 2

2021-04-20

Symptoms: Worsening of myasthenia gravis. Increased muscle weakness, fatigue, and difficulty standing up and walking. Thigh muscles have been the weakest.

Release 8 — day 28, dose 2

2021-04-27

Symptoms: Worsening of myasthenia gravis (more days bed ridden or with difficulty walking) after having been in remission from Sept. 2019 to Mar. 2021.

Release 8 — day 35, dose 2

2021-05-05

Symptoms: Mild worsening of muscle weakness from myasthenia gravis.Gastrointestinal upset - bloating, flatulence, dysmotility.

Release 8 — day 42, dose 2

2021-05-11

Symptoms: Bloating and flatulence

Release 9 — 3 months, dose 2

2021-06-30

Symptoms: Salivary gland infection, treated effectively with antibiotics.

Release 9 — day 0, dose 3

2021-08-18

Systemic reaction (other): Mild muscle weakness related to myasthenia gravis

Release 9 — days 1–6 daily, dose 3

2021-08-20

Systemic reaction (other): Swelling and pain in armpit near injection site. Tightness in chest & neck. Increased symptoms of muscle weakness from myasthenia gravis.

2021-08-21

Systemic reaction (other): Swollen glands in neck; tightness in chest, neck, and shoulder near injection site; swollen, painful armpit near injection site; Somnolence, sleeping excessively

2021-08-22

Systemic reaction (other): Lightheadedness and weakness when standing up or sitting up; I had to lie down again quickly.

2021-08-23

Systemic reaction (other): Swelling and pain in armpit near injection site. Insomnia.

2021-08-24

Systemic reaction (other): Insomnia.

Release 9 — day 7, dose 3

2021-08-25

Systemic reaction (other): Insomnia. I was incredibly tired and slept a lot for the 1st 3 full days after the shot, and have slept little or not at all for the next 4th-6th days

Release 9 — day 14, dose 3

2021-09-03

Symptoms: Lymph nodes in right armpit (arm of injection) still feel inflamed. I saw my neurologist on Sept. 1, 2021 to discuss severe reaction to 3rd dose of Moderna vaccine. I see my immunologist on Sept. 4, 2021. I have myasthenia gravis & immunodeficiency. cut off by CDC

Release 9 — day 21, dose 3

2021-09-08

Symptoms: Worsening of rash on ny back. The rash has been on my back since 1st week of July 2021 prior to vaccine. Insomnia. Loss of appetite.

Release 9 — day 28, dose 3

2021-09-17

Symptoms: Rash on back. I saw a dermatologist. I also saw my immunologist. She says I have a primary immunodeficiency due to a CARD 11 mutation + mild total IgG & IgG subclass deficiencies of unknown cause.

Release 9 — day 35, dose 3

2021-09-22

Symptoms: Rash of itchy red bumps over back continues.

Release 9 — day 42, dose 3

2021-09-29

Symptoms: Rash on back continues. It is not responding to prescriptions from dermatologist.

Release 10 — 3 months, dose 3

2021-11-19

Symptoms: Infection of left submandibular salivary gland with drainage into left side of nose. Urinary tract infection. Hemorrhagic ovarian cyst. Rash on back of itchy, painful red bumps finally cleared up after lasting months. Inability to get pregnant.

Healthcare visit (other): Hospital appointments scheduled

Release 11 — 6 months, dose 3

2022-02-18

Symptoms: Rash of small red bumps over entire back, chest, back of neck, scalp, and chin since 11/25/2021. Salivary gland infection and sinus infection from 11/9 to 12/20/2021 and sinus infection from 1/13 to 2/8/2022. Hypothyroidism since 1/13/2022.

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	Abdominal discomfort	✓	✓	✓
SD	Abdominal distension	✓	✓	✓
SD	Bedridden	✓	✓	✓
SD	Blood immunoglobulin G decreased	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Decreased appetite	·	·	✓
SD	Dysstasia	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Flatulence	✓	✓	✓
SD	Gait disturbance	✓	✓	✓
SD	Gastrointestinal motility disorder	✓	✓	✓
SD	Gene mutation	·	·	✓
SD	Haemorrhagic ovarian cyst	·	·	✓
SD	Hypothyroidism	·	·	✓
SD	Infertility female	·	·	✓
SD	Insomnia	·	·	✓
SD	Lymphadenitis	✓	·	✓
SD	Muscular weakness	✓	✓	✓
SD	Myasthenia gravis	✓	✓	✓
SD	Office visit	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Primary immunodeficiency syndrome	·	·	✓
SD	Rash	·	·	✓
SD	Rash erythematous	·	·	✓
SD	Rash pruritic	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Selective IgG subclass deficiency	·	·	✓
SD	Sialoadenitis	✓	✓	✓
SD	Sinusitis	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Asthenia	✓	·	✓
SRO	Axillary pain	✓	·	✓
SRO	Chest discomfort	✓	·	✓
SRO	Dizziness	✓	·	✓
SRO	Dysstasia	✓	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Hypersomnia	✓	·	✓
SRO	Insomnia	✓	·	✓
SRO	Joint stiffness	✓	·	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Muscle tightness	✓	·	✓
SRO	Muscular weakness	✓	✓	✓
SRO	Myasthenia gravis	✓	·	✓
SRO	Oedema peripheral	✓	·	✓
SRO	Pre-existing disease	✓	·	✓
SRO	Somnolence	✓	·	✓

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