4SY-22402-11498

3 vaccinations 13 coded responses 21 check-ins 13 free-text entries 13 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 194 / PA
Registered: 2021-02-08

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

6PW-19360-78611 Child or adolescent in my care · Male · 2021-12-08

USX-93591-17684 Child or adolescent in my care · Male · 2021-12-08

Timeline

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

2021-02-06
Dose 1 — Moderna
2021-02-08
Registered in v-safe
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Dyspnoea — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Chest pain and difficulty breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Report sent to call center — days 1–6 daily, dose 1
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)
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Back pain, Burning sensation, Neck pain, Pain in extremity — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Feels like arm back and neck is burning and on fire on top of pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Amnesia, Feeling abnormal — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Brain Fog and acute short term memory loss

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — day 7, dose 1
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-20
Survey response — day 14, dose 1
MedDRA: Arthralgia, Bedridden, Chills, Erythema, Hyperhidrosis, Myalgia, Office visit, Peripheral swelling, Pre-existing disease, Pyrexia, Skin warm — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Fever of 101.5+ ; even after taking Tylenol q4hSweating and chills Muscle and joint painsArm still red warm swollenHave been in bed since last weekHave lupus SLE, Ankylosing Spondylitis, Diabetes, etc - side effects were delayed a few days · Healthcare visit (other): Dr said to stay home if possible vs going to the ER and getting sicker since this is the first shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Report sent to call center — day 14, dose 1
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)
2021-02-27
Survey response — day 21, dose 1
MedDRA: Arthralgia, Chills, Myalgia, Peripheral swelling, Pyrexia, Skin warm — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Fevers 100-103.4+++ChillsMuscle and joint painStill swollen arm hot to the touch

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Report sent to call center — day 21, dose 1
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)
2021-03-06
Dose 2 — Moderna
2021-03-06
Health check-in — day 0, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-03-08
Report sent to call center — days 1–6 daily, 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)
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Chest pain, Fatigue, Joint swelling, Migraine, Pallor, Spinal pain — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, 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: Systemic reaction (other): PLEASE HELP Every SINGLE joint is SWOLLEN, BURNING IN PAIN TURNS WHITE WHEN I MOVE IT INCLUDING FINGERS TOES FEET ANKLES WRISTS ELBOWS AND CHEST AND SPINAL PAIN. EVERY JOINT FROM HEAD TO TOE · Healthcare visit (other): Every single joint is swollen, BURNING IN PAIN TURNS WHITE WHEN I MOVE IT AND CHEST AND SPINAL PAIN. EVERY JOINT FROM HEAD TO TOE I DON'T KNOW WHAT TO DO AND TIRED AND WORST MIGRAINE AND CHEST PAIN EVER PHONE (b)(6)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Report sent to call center — days 1–6 daily, 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)
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Joint swelling, Peripheral swelling — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, 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: Hands wrists swollen all joints are still swollen and worse than yesterday please help

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — days 1–6 daily, 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)
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-03-11
Report sent to call center — days 1–6 daily, 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)
2021-03-15
Health check-in — day 7, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, 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

Adult check-in
2021-03-15
Report sent to call center — day 7, 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)
2021-03-20
Survey response — day 14, dose 2
MedDRA: Abdominal pain, Arthralgia, Myalgia, Nausea, Pyrexia — Feeling: Poor · Be unable to work, 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: Fever muscle joint pain swelling everywhere nauseaus abdominal pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 14, 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)
2021-04-03
Survey response — day 28, dose 2
MedDRA: Condition aggravated, Medical counselling, Nausea, Pain — Feeling: Poor · Be unable to work, 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: Lupus and Ankylosing Spondylitis is worsening.bi feel bedridden nauseas and am on 7 different nausea meds and NOTHING is working. My pain is worse. This is worse than heck. I'm a mom... I need to be up and moving · Healthcare visit (other): Dr calls daily because I'm getting worse vs better

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
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)
2021-06-05
Survey response — 3 months, dose 2
MedDRA: Ankylosing spondylitis, General physical health deterioration, Pre-existing disease, Systemic lupus erythematosus — Feeling: Poor · Be unable to work, 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, Emergency room or emergency department visit

Free text: Lupus and Ankylosing Spondylitis have worsened. Overall health has seriously decreased.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-05
Report sent to call center — 3 months, 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)
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-06-15
Call successful
Participant prefers to complete VAERS report online
2021-12-03
Dose 3 — Moderna
2021-12-08
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-09
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-12-11
Survey response — day 7, dose 3
MedDRA: Brain fog, Migraine — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · 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

Free text: Migraine and brain fog

MedDRA releases: 2024-11 · check-in free text available
2021-12-11
Report sent to call center — day 7, 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 · 1 call case(s)
2021-12-13
Call 1 — Left Voicemail
2021-12-17
Survey response — day 14, dose 3
MedDRA: Arthralgia, Back pain, Brain fog, Headache, Migraine, Muscular weakness, Myalgia, Neck pain, Pyrexia — 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: Migraine, muscle weakness, brain fog, low grade fever, joint and muscle pain, back and neck pain and worst headache of my life.

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Report sent to call center — day 14, 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)
2021-12-24
Survey response — day 21, dose 3
MedDRA: Abdominal pain, Arthralgia, Diarrhoea, Migraine, Myalgia, Pain in extremity, Pyrexia, Respiratory tract congestion, Vomiting — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Migraines, fever, vomiting abdominal pain, diarrhea, congested and muscle and joint pain seperate from their arms hurting

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-06	Moderna
2	2021-03-06	Moderna
3	2021-12-03	Moderna	No

Call center

13 call center cases

11 successful · 2 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-08

Systemic reaction (other): Chest pain and difficulty breathing

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Feels like arm back and neck is burning and on fire on top of pain.

2021-02-11

Systemic reaction (other): Brain Fog and acute short term memory loss

Release 4 — day 14, dose 1

2021-02-20

Symptoms: Fever of 101.5+ ; even after taking Tylenol q4hSweating and chills Muscle and joint painsArm still red warm swollenHave been in bed since last weekHave lupus SLE, Ankylosing Spondylitis, Diabetes, etc - side effects were delayed a few days

Healthcare visit (other): Dr said to stay home if possible vs going to the ER and getting sicker since this is the first shot

Release 4 — day 21, dose 1

2021-02-27

Symptoms: Fevers 100-103.4+++ChillsMuscle and joint painStill swollen arm hot to the touch

Release 5 — days 1–6 daily, dose 2

2021-03-09

Systemic reaction (other): PLEASE HELP Every SINGLE joint is SWOLLEN, BURNING IN PAIN TURNS WHITE WHEN I MOVE IT INCLUDING FINGERS TOES FEET ANKLES WRISTS ELBOWS AND CHEST AND SPINAL PAIN. EVERY JOINT FROM HEAD TO TOE

Healthcare visit (other): Every single joint is swollen, BURNING IN PAIN TURNS WHITE WHEN I MOVE IT AND CHEST AND SPINAL PAIN. EVERY JOINT FROM HEAD TO TOE I DON'T KNOW WHAT TO DO AND TIRED AND WORST MIGRAINE AND CHEST PAIN EVER PHONE (b)(6)

redacted (b)(6)

2021-03-10

Systemic reaction (other): Hands wrists swollen all joints are still swollen and worse than yesterday please help

Release 6 — day 14, dose 2

2021-03-20

Symptoms: Fever muscle joint pain swelling everywhere nauseaus abdominal pain

Release 6 — day 28, dose 2

2021-04-03

Symptoms: Lupus and Ankylosing Spondylitis is worsening.bi feel bedridden nauseas and am on 7 different nausea meds and NOTHING is working. My pain is worse. This is worse than heck. I'm a mom... I need to be up and moving

Healthcare visit (other): Dr calls daily because I'm getting worse vs better

Release 8 — 3 months, dose 2

2021-06-05

Symptoms: Lupus and Ankylosing Spondylitis have worsened. Overall health has seriously decreased.

Release 10 — day 7, dose 3

2021-12-11

Systemic reaction (other): Migraine and brain fog

Release 10 — day 14, dose 3

2021-12-17

Symptoms: Migraine, muscle weakness, brain fog, low grade fever, joint and muscle pain, back and neck pain and worst headache of my life.

Release 10 — day 21, dose 3

2021-12-24

Symptoms: Migraines, fever, vomiting abdominal pain, diarrhea, congested and muscle and joint pain seperate from their arms hurting

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	Arthralgia	✓	✓	✓
HCVO	Chest pain	✓	✓	✓
HCVO	Fatigue	✓	✓	✓
HCVO	Joint swelling	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Migraine	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Pallor	✓	✓	✓
HCVO	Spinal pain	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Ankylosing spondylitis	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Bedridden	✓	✓	✓
SD	Brain fog	·	·	✓
SD	Chills	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Erythema	✓	✓	✓
SD	General physical health deterioration	✓	✓	✓
SD	Headache	·	·	✓
SD	Hyperhidrosis	✓	✓	✓
SD	Migraine	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Neck pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Skin warm	✓	✓	✓
SD	Systemic lupus erythematosus	✓	✓	✓
SD	Vomiting	·	·	✓
SRO	Amnesia	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Brain fog	·	·	✓
SRO	Burning sensation	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Joint swelling	✓	✓	✓
SRO	Migraine	·	·	✓
SRO	Neck pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pallor	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Spinal pain	✓	✓	✓

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