55A-93019-25626

4 vaccinations 11 coded responses 43 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 921 / CA
Registered: 2021-01-24

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

2021-01-24
Registered in v-safe
2021-01-24
Dose 1 — Moderna
2021-01-24
Survey response — day 0, dose 1
MedDRA: Pain, Pain in extremity — Feeling: Good · Site: Pain

Free text: Arm pain with movement

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-14
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-21
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-23
Dose 2 — Moderna
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: More fatigue than usual last few evenings

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-16
Survey response — day 21, dose 2
MedDRA: Fatigue — Feeling: Fair

Free text: More fatigue earlier in the evening, and tired when awakening.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-30
Survey response — day 35, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: More early evening fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

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

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

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 — day 7, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-10
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-26
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-18
Dose 4 — Moderna
2022-04-21
Survey response — days 1–6 daily, dose 4
MedDRA: Fatigue, Pre-existing disease — Feeling: Fair · Rash, not including the immediate area around the injection site

Free text: More fatigue than usual 2days after vaccine

MedDRA releases: 2024-11 · check-in free text available
2022-04-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2022-04-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-24
Survey response — days 1–6 daily, dose 4
MedDRA: Anxiety — Feeling: Poor · Site: Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Anxiety

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Health check-in — day 7, dose 4
Feeling: Fair · Site: Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-04
Survey response — day 14, dose 4
MedDRA: Asthenia, Pruritus — Feeling: Fair

Free text: Increased itching, less energy

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Survey response — day 28, dose 4
MedDRA: Pruritus, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Increased itching and rash

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-17
Call 1 — Left Voicemail
2022-05-27
Survey response — day 35, dose 4
MedDRA: Fatigue, Pruritus — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Increased fatigue several days. Pruritis (increased itching.

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-01
Call 2 — Left Voicemail
2022-06-01
Call 1 — Left Voicemail
2022-07-24
Survey response — 3 months, dose 4
MedDRA: Ataxia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Continuing ataxia

MedDRA releases: 2024-11 · check-in free text available
2022-07-24
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-07-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-19
Survey response — 6 months, dose 4
MedDRA: Balance disorder, Coordination abnormal, Office visit, Pruritus — Feeling: Fair · 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: Severe itching has continued, and also increased balance and coordination problems. I have had CT scan, MRI (brain) which were wnl. Have had lab work, so far normal limits. I have seen Dermatologist, Allergist, and Neurologist, and so far no answers!

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-10-20
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-24	Moderna
2	2021-02-23	Moderna
3	2021-10-27	Moderna	No
4	2022-04-18	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 2 — day 0, dose 1

2021-01-24

Systemic reaction (other): Arm pain with movement

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): More fatigue than usual last few evenings

Release 5 — day 21, dose 2

2021-03-16

Symptoms: More fatigue earlier in the evening, and tired when awakening.

Release 6 — day 35, dose 2

2021-03-30

Symptoms: More early evening fatigue

Release 11 — days 1–6 daily, dose 4

2022-04-21

Systemic reaction (other): More fatigue than usual 2days after vaccine

2022-04-24

Systemic reaction (other): Anxiety

Release 11 — day 14, dose 4

2022-05-04

Symptoms: Increased itching, less energy

Release 11 — day 28, dose 4

2022-05-16

Symptoms: Increased itching and rash

Release 11 — day 35, dose 4

2022-05-27

Symptoms: Increased fatigue several days. Pruritis (increased itching.

Release 12 — 3 months, dose 4

2022-07-24

Symptoms: Continuing ataxia

Release 12 — 6 months, dose 4

2022-10-19

Symptoms: Severe itching has continued, and also increased balance and coordination problems. I have had CT scan, MRI (brain) which were wnl. Have had lab work, so far normal limits. I have seen Dermatologist, Allergist, and Neurologist, and so far no answers! cut off by CDC

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	Asthenia	·	·	✓
SD	Ataxia	·	·	✓
SD	Balance disorder	·	·	✓
SD	Coordination abnormal	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Office visit	·	·	✓
SD	Pruritus	·	·	✓
SD	Rash	·	·	✓
SRO	Anxiety	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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