4YC-18535-71224

4 vaccinations 4 coded responses 43 check-ins 3 free-text entries 1 call case

Sex: Female
Age at first dose: 31-35
ZIP prefix: 463 / IN
Registered: 2021-03-12

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Registered dependents

QCV-28622-45172 Child or adolescent in my care · Female · 2022-06-25

ZWG-24027-34535 Child or adolescent in my care · Male · 2023-04-14

Timeline

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

2021-02-12
Dose 1 — Moderna
2021-03-12
Registered in v-safe
2021-03-12
Dose 2 — Moderna
2021-03-12
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site rash — Feeling: Good · Site: Pain

Free text: I still have a square rash near the injection site of my first dose. It does not itch, hurt, or bother me in any way aside from me being able to see it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-11
Survey response — 3 months, dose 2
MedDRA: Palpitations, Pre-existing disease — Feeling: Good

Free text: Just started noticing heart palpitations a day or so ago but I have felt them before in the past.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Dose 3 — Moderna
2021-10-29
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-05
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-10
Health check-in — day 42, dose 3
Feeling: Good

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

Adult check-in
2022-04-29
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-07
Dose 4 — Moderna
2022-09-08
Survey response — days 1–6 daily, dose 4
MedDRA: Chest discomfort — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches

Free text: Occasional mild chest discomfort

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache

Adult check-in
2022-09-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache

Adult check-in
2022-09-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-16
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-09-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-09-28
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-05
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-12
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-10-19
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-07
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-08
Survey response — 6 months, dose 4
MedDRA: Cardiovascular symptom, Dyspepsia, Emergency care — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-03-08
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2023-03-09
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna
3	2021-10-29	Moderna	No
4	2022-09-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2023-03-08	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-16

Systemic reaction (other): I still have a square rash near the injection site of my first dose. It does not itch, hurt, or bother me in any way aside from me being able to see it.

Release 9 — 3 months, dose 2

2021-06-11

Symptoms: Just started noticing heart palpitations a day or so ago but I have felt them before in the past.

Release 12 — days 1–6 daily, dose 4

2022-09-08

Systemic reaction (other): Occasional mild chest discomfort

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	Cardiovascular symptom	·	·	✓
SD	Dyspepsia	·	·	✓
SD	Emergency care	·	·	✓
SD	Palpitations	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SRO	Chest discomfort	·	·	✓
SRO	Injection site rash	✓	✓	✓

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