4UH-23334-50817

4 vaccinations 8 coded responses 41 check-ins 8 free-text entries 3 call cases

Sex: Female
Age at first dose: 21-25
ZIP prefix: 660 / KS
Registered: 2020-12-23

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

2020-12-23
Registered in v-safe
2020-12-23
Dose 1 — Moderna
2020-12-23
Survey response — day 0, dose 1
MedDRA: Paraesthesia — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Tingling of arm and abdomen on the same side of injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-23
Report sent to call center — day 0, dose 1
Be unable to do your normal daily activities

1 call case(s)
2020-12-24
Survey response — days 1–6 daily, dose 1
MedDRA: Confusional state, Depression, Hypoaesthesia, Paraesthesia — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Severe depression, numbness and tingling in upper extremeties, confusion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2020-12-24
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2020-12-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-30
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-20
Dose 2 — Moderna
2021-01-21
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Ear pain, Neuralgia — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Nerve pain, ear ache, chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Abdominal pain

Adult check-in
2021-01-29
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 35, dose 2
Feeling: Good

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

Adult check-in
2021-04-25
Survey response — 3 months, dose 2
MedDRA: Chest pain — Feeling: Good

Free text: Reoccurring chest pains

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-21
Survey response — 6 months, dose 2
MedDRA: Amenorrhoea — Feeling: Good

Free text: Amenorrhea

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Dose 3 — Moderna
2021-12-10
Health check-in — day 0, dose 3
Feeling: Poor · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-11
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal pain upper, Uterine spasm — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Stomach/uterine cramping

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-14
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-16
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache

Adult check-in
2021-12-17
Survey response — day 7, dose 3
MedDRA: Chest discomfort — Feeling: Good

Free text: Chest tightness

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-02
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-07
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-14
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-21
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-03-11
Survey response — 3 months, dose 3
MedDRA: Influenza like illness, Intervertebral disc protrusion, Nasopharyngitis, SARS-CoV-2 test negative — 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 · Outpatient clinic or urgent care clinic visit

Free text: Herniated disc in neck, cold/flu like symptoms but neg covid test

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
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 · 1 call case(s)
2022-03-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-06-10
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-25
Dose 4 — Moderna
Co-administered: Flu
2022-09-25
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-09-26
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-27
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-10-01
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-03
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-10-09
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-01
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-06
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-25
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-28
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-23	Moderna
2	2021-01-20	Moderna
3	2021-12-10	Moderna	No
4	2022-09-25	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2020-12-23	priority 2/3
2020-12-24	priority 2/3
2022-03-11	Successful 2022-03-14	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 1 — day 0, dose 1

2020-12-23

Systemic reaction (other): Tingling of arm and abdomen on the same side of injection site

Release 1 — days 1–6 daily, dose 1

2020-12-24

Systemic reaction (other): Severe depression, numbness and tingling in upper extremeties, confusion

Release 2 — days 1–6 daily, dose 2

2021-01-21

Systemic reaction (other): Nerve pain, ear ache, chest pain

Release 7 — 3 months, dose 2

2021-04-25

Symptoms: Reoccurring chest pains

Release 9 — 6 months, dose 2

2021-07-21

Symptoms: Amenorrhea

Release 10 — days 1–6 daily, dose 3

2021-12-11

Systemic reaction (other): Stomach/uterine cramping

Release 10 — day 7, dose 3

2021-12-17

Systemic reaction (other): Chest tightness

Release 11 — 3 months, dose 3

2022-03-11

Symptoms: Herniated disc in neck, cold/flu like symptoms but neg covid test

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	Amenorrhoea	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Influenza like illness	·	·	✓
SD	Intervertebral disc protrusion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Abdominal pain upper	·	·	✓
SRO	Chest discomfort	·	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Confusional state	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Neuralgia	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Uterine spasm	·	·	✓

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