4XN-14893-52395

3 vaccinations 14 coded responses 38 check-ins 14 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 917 / CA
Registered: 2021-03-15

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-15
Registered in v-safe
2021-03-15
Dose 1 — Moderna
2021-03-15
Health check-in — day 0, dose 1
Feeling: Fair · Chills

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate decreased — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Slow heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate decreased — Feeling: Fair · Headache

Free text: Lower heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-24
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-05
Survey response — day 21, dose 1
MedDRA: Heart rate decreased, Rash — Feeling: Fair

Free text: Rash on my hands. Not sure what it is caused from. Still have lower heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Dose 2 — Moderna
2021-04-23
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Nausea

Adult check-in
2021-04-24
Survey response — days 1–6 daily, dose 2
MedDRA: Gastritis — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches

Free text: Gastritis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Flatulence — Feeling: Fair · Site: Pain · Joint pains

Free text: Feel like i have a gas bubble trapped in my ribcage/chest

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate decreased — Feeling: Fair · Site: Pain · Nausea

Free text: Low heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Nausea

Adult check-in
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Cardiac flutter, Heart rate decreased — Feeling: Fair

Free text: Lower heart rate, felt heart fluttering

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased, Nausea — Feeling: Good · Nausea

Free text: Had a little nausea. Found i had a increase heart rate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Survey response — day 7, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Joint pains, Fatigue or tiredness

Free text: I have ankylosing spondylitis so i believe it may have triggered

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Survey response — day 14, dose 2
MedDRA: Headache, Nausea — Feeling: Fair

Free text: Headaches and nauseated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-25
Survey response — 3 months, dose 2
MedDRA: Condition aggravated, Headache, Palpitations, Pre-existing disease — Feeling: Good

Free text: Flair up of my Ankylosing Spondylitis. Head aches, heart palpations

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-18
Call successful
Participant prefers to complete VAERS report online
2022-01-15
Dose 3 — Moderna
2022-01-15
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Headache, Nausea

Adult check-in
2022-01-16
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains

Adult check-in
2022-01-17
Survey response — days 1–6 daily, dose 3
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school

Free text: I have Ankylosing spondylitis and it feels like i am having a flair in some of my problem joints

MedDRA releases: 2024-11 · check-in free text available
2022-01-19
Survey response — days 1–6 daily, dose 3
MedDRA: Ankylosing spondylitis, Pre-existing disease — Feeling: Fair · Joint pains

Free text: I have ankylosing spondylitis so it feels more like a flair now but is getting much better than the last few days.

MedDRA releases: 2024-11 · check-in free text available
2022-01-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-01-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains

Adult check-in
2022-01-22
Survey response — day 7, dose 3
MedDRA: Adverse reaction — Feeling: Fair · Headache

Free text: Allergy symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-01-29
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2022-02-05
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-02-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-19
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-04-16
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-07-16
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2023-01-17
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-15	Moderna
2	2021-04-23	Moderna
3	2022-01-15	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-17

Systemic reaction (other): Slow heart rate

2021-03-18

Systemic reaction (other): Lower heart rate

Release 6 — day 21, dose 1

2021-04-05

Symptoms: Rash on my hands. Not sure what it is caused from. Still have lower heart rate

Release 7 — days 1–6 daily, dose 2

2021-04-24

Systemic reaction (other): Gastritis

2021-04-25

Systemic reaction (other): Feel like i have a gas bubble trapped in my ribcage/chest

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): Low heart rate

2021-04-28

Systemic reaction (other): Lower heart rate, felt heart fluttering

2021-04-29

Systemic reaction (other): Had a little nausea. Found i had a increase heart rate

Release 8 — day 7, dose 2

2021-04-30

Systemic reaction (other): I have ankylosing spondylitis so i believe it may have triggered

Release 8 — day 14, dose 2

2021-05-07

Symptoms: Headaches and nauseated

Release 9 — 3 months, dose 2

2021-07-25

Symptoms: Flair up of my Ankylosing Spondylitis. Head aches, heart palpations

Release 10 — days 1–6 daily, dose 3

2022-01-17

Systemic reaction (other): I have Ankylosing spondylitis and it feels like i am having a flair in some of my problem joints

2022-01-19

Systemic reaction (other): I have ankylosing spondylitis so it feels more like a flair now but is getting much better than the last few days.

Release 11 — day 7, dose 3

2022-01-22

Systemic reaction (other): Allergy symptoms

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	Condition aggravated	✓	·	✓
SD	Headache	✓	✓	✓
SD	Heart rate decreased	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Palpitations	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Rash	✓	✓	✓
SRO	Adverse reaction	·	·	✓
SRO	Ankylosing spondylitis	·	·	✓
SRO	Cardiac flutter	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Flatulence	✓	✓	✓
SRO	Gastritis	✓	✓	✓
SRO	Heart rate decreased	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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