58E-23126-04606

3 vaccinations 11 coded responses 41 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 074 / NJ
Registered: 2021-02-05

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

2021-02-05
Registered in v-safe
2021-02-05
Dose 1 — Moderna
2021-02-05
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Energy increased, Feeling abnormal, Flushing — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Slightly light headed at times, other times foggy, and others extra energy. Some flushing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal, Hot flush — Feeling: Good · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Hot flash when walking and then had to lay down as I was left feeling under the weather. Felt better after

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus pain — Feeling: Good · Headache

Free text: Sinus 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: Palpitations — Feeling: Good

Free text: Minor Palpitations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Musculoskeletal stiffness — Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Stiff muscles

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Muscle or body aches

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-15
Dose 3 — Moderna
2021-11-15
Survey response — day 0, dose 3
MedDRA: Axillary pain — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Pain in armpit

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-17
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-18
Survey response — days 1–6 daily, dose 3
MedDRA: Contusion, Pain in extremity, Wrong technique in product usage process — Feeling: Good · Site: Pain

Free text: The person who administered my vaccine stabbed me too hard. User error is why my arm hurts and is bruised.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal pain, Dizziness — Feeling: Poor · Diarrhea, Abdominal pain · 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: Very intense abdominal pain yesterday to the point of feeling faint.

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — days 1–6 daily, 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)
2021-11-20
Survey response — days 1–6 daily, dose 3
MedDRA: Contusion — Feeling: Good

Free text: Still bruised on arm

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site bruising — Feeling: Good · Fatigue or tiredness

Free text: Still bruised from the shot.

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Health check-in — day 7, dose 3
Feeling: Fair · Abdominal pain

Adult check-in
2021-11-23
Call 1 — Left Voicemail
2021-11-23
Call successful
Participant prefers to complete VAERS report online
2021-11-29
Survey response — day 14, dose 3
MedDRA: Abdominal pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Abdominal pain

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-13
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-20
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-27
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-14
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-16
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-17
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-11-15	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-06

Systemic reaction (other): Slightly light headed at times, other times foggy, and others extra energy. Some flushing

2021-02-07

Systemic reaction (other): Hot flash when walking and then had to lay down as I was left feeling under the weather. Felt better after

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Sinus pain

2021-02-11

Systemic reaction (other): Minor Palpitations

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Stiff muscles

Release 10 — day 0, dose 3

2021-11-15

Systemic reaction (other): Pain in armpit

Release 10 — days 1–6 daily, dose 3

2021-11-18

Systemic reaction (other): The person who administered my vaccine stabbed me too hard. User error is why my arm hurts and is bruised.

2021-11-19

Systemic reaction (other): Very intense abdominal pain yesterday to the point of feeling faint.

2021-11-20

Systemic reaction (other): Still bruised on arm

2021-11-21

Systemic reaction (other): Still bruised from the shot.

Release 10 — day 14, dose 3

2021-11-29

Symptoms: Abdominal pain

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	Abdominal pain	·	·	✓
SRO	Abdominal pain	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Contusion	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Energy increased	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Hot flush	✓	✓	✓
SRO	Injection site bruising	·	·	✓
SRO	Musculoskeletal stiffness	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Palpitations	✓	✓	✓
SRO	Sinus pain	✓	✓	✓
SRO	Wrong technique in product usage process	·	·	✓

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