5DE-11130-61109

2 vaccinations 9 coded responses 18 check-ins 9 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 923 / CA
Registered: 2021-01-10

Relationship: Self
Race: Asian
Ethnicity: N/A

Timeline

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

2020-12-28
Dose 1 — Moderna
2021-01-10
Registered in v-safe
2021-01-11
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site induration, Injection site swelling, Specialist consultation — Feeling: Fair · Be unable to do your normal daily activities

Free text: It's about three days ago my arm is very red hard and swollen I saw my PCP today and he said to report to you all

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-26
Dose 2 — Moderna
2021-01-26
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain, Swelling · Fever · None · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Didnt use any of these choices.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Report sent to call center — day 0, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-27
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: All my symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Swelling, Itching · Headache, Fatigue or tiredness · Be unable to work

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Headache, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain, Swelling, Itching · Chills, Headache, Abdominal pain · Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — days 1–6 daily, dose 2
MedDRA: Restlessness — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Restlessness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-03
Health check-in — day 7, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Headache, Fatigue or tiredness, Abdominal pain · Be unable to work

Adult check-in
2021-02-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-02
Survey response — day 35, dose 2
MedDRA: Dizziness, Headache, Impaired work ability, Pyrexia, Vomiting — Feeling: Good · Be unable to work

Free text: On Thursday 2:5th February came down with fever vomiting headache dizziness couldnt go to work for the rest of the week

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-27
Survey response — 3 months, dose 2
MedDRA: Depressed mood, Headache, Impaired work ability, Office visit, Telemedicine — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Ever since I got the Covid vaccine it left me with a constant headache and I very depressed I am seeking medical help and I am now placed on medical leave · Healthcare visit (other): Both in patient and virtual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-30
Call 1 — Left Voicemail
2021-06-03
Call 2 — Left Voicemail
2021-06-04
Call 3 — Left Voicemail
2021-06-10
Call X — Left Voicemail
2021-06-11
Call successful
Participant prefers to complete VAERS report online
2021-07-28
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-01-27
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-28	Moderna
2	2021-01-26	Moderna

Call center

4 call center cases

3 successful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 1 — day 14, dose 1

2021-01-11

Symptoms: It's about three days ago my arm is very red hard and swollen I saw my PCP today and he said to report to you all

Release 2 — day 0, dose 2

2021-01-26

Healthcare visit (other): Didnt use any of these choices.

Release 2 — days 1–6 daily, dose 2

2021-01-27

Systemic reaction (other): No

2021-01-28

Systemic reaction (other): All my symptoms

Release 3 — days 1–6 daily, dose 2

2021-01-29

Systemic reaction (other): No

2021-01-31

Systemic reaction (other): No

2021-02-01

Systemic reaction (other): Restlessness

Release 4 — day 35, dose 2

2021-03-02

Symptoms: On Thursday 2:5th February came down with fever vomiting headache dizziness couldnt go to work for the rest of the week

Release 8 — 3 months, dose 2

2021-04-27

Symptoms: Ever since I got the Covid vaccine it left me with a constant headache and I very depressed I am seeking medical help and I am now placed on medical leave

Healthcare visit (other): Both in patient and virtual

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
HCVO	No adverse event	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Telemedicine	✓	✓	✓
SD	Depressed mood	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Impaired work ability	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site induration	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Specialist consultation	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Restlessness	✓	✓	✓

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