5JP-48205-99486

3 vaccinations 6 coded responses 36 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 146 / NY
Registered: 2020-12-27

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Registered dependents

HDQ-87784-01999 Child or adolescent in my care · Female · 2022-01-23

Timeline

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

2020-12-26
Dose 1 — Moderna
2020-12-27
Registered in v-safe
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Joint pains, Fatigue or tiredness, Nausea

Adult check-in
2020-12-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Joint pains

Adult check-in
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Diarrhea

Adult check-in
2020-12-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-01-02
Health check-in — day 7, dose 1
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Adult check-in
2021-01-02
Report sent to call center — day 7, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-09
Survey response — day 14, dose 1
MedDRA: Histamine intolerance, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I'm having a delayed histamine response from the shot. Have been to urgent care multiple times for it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-09
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-16
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-23
Dose 2 — Moderna
2021-01-23
Health check-in — day 0, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-13
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-02-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-24
Survey response — 3 months, dose 2
MedDRA: Office visit, Periarthritis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Frozen shoulder... in the arm I got my shots in · Healthcare visit (other): Ortho

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-09
Call 1 — Left Voicemail
2021-07-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-19
Dose 3 — Moderna
2022-01-23
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-01-23
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Nausea

Adult check-in
2022-01-24
Survey response — days 1–6 daily, dose 3
MedDRA: Chest pain — Feeling: Fair · Site: Pain, Swelling, Itching · Fever

Free text: Chest pain

MedDRA releases: 2024-11 · check-in free text available
2022-01-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · None

Adult check-in
2022-01-26
Health check-in — day 7, dose 3
Feeling: Poor · Site: Redness · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-02-02
Survey response — day 14, dose 3
MedDRA: Aphonia, Paranasal sinus discomfort — Feeling: Poor · Be unable to work or attend school

Free text: Loss of voice, severe sinus pressure

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Survey response — day 21, dose 3
MedDRA: Muscle spasms — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Spastic neck muscles.

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Report sent to call center — day 21, 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

Emergency room or emergency department visit · 1 call case(s)
2022-02-10
Call 1 — Left Voicemail
2022-02-18
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-24
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-03-02
Survey response — day 42, dose 3
MedDRA: Malaise — Feeling: Fair

Free text: I'm sick

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2023-01-21
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-26	Moderna
2	2021-01-23	Moderna
3	2022-01-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-02	Unsuccessful
2021-01-09	Unsuccessful
2021-04-24	Unsuccessful
2022-02-09	Unsuccessful

Free text

Release 1 — day 14, dose 1

2021-01-09

Symptoms: I'm having a delayed histamine response from the shot. Have been to urgent care multiple times for it.

Release 7 — 3 months, dose 2

2021-04-24

Symptoms: Frozen shoulder... in the arm I got my shots in

Healthcare visit (other): Ortho

Release 11 — days 1–6 daily, dose 3

2022-01-24

Systemic reaction (other): Chest pain

Release 11 — day 14, dose 3

2022-02-02

Symptoms: Loss of voice, severe sinus pressure

Release 11 — day 21, dose 3

2022-02-09

Symptoms: Spastic neck muscles.

Release 11 — day 42, dose 3

2022-03-02

Symptoms: I'm sick

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	Office visit	✓	✓	✓
SD	Aphonia	·	·	✓
SD	Histamine intolerance	✓	✓	✓
SD	Malaise	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Office visit	✓	✓	✓
SD	Paranasal sinus discomfort	·	·	✓
SD	Periarthritis	✓	✓	✓
SRO	Chest pain	·	·	✓

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