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5MR-32860-53328

2 vaccinations 12 coded responses 18 check-ins 12 free-text entries 3 call cases
Sex
Female
Age at first dose
61-65
ZIP prefix
480 / MI
Registered
2021-02-14
Relationship
Self
Race
Black or African American
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-12
    Dose 1 — Moderna
  2. 2021-02-14
    Registered in v-safe
  3. 2021-02-15
    Survey response — days 1–6 daily, dose 1
    MedDRA: Constipation, Dry mouth, Lip dry — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities
    Free text: Extreme dry mouth and lips. Unusual constipation.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-16
    Survey response — days 1–6 daily, dose 1
    MedDRA: Constipation, Dry mouth, Flatulence, Lip dry — Feeling: Good
    Free text: Mild dryness of mouth and lips. Milder Constipation and gas
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-02-17
    Survey response — days 1–6 daily, dose 1
    MedDRA: Flatulence — Feeling: Good · Abdominal pain
    Free text: Gas
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-02-18
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-02-21
    Survey response — day 7, dose 1
    MedDRA: Abdominal discomfort — Feeling: Good
    Free text: Some stomach discomfort still
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-02-26
    Survey response — day 14, dose 1
    MedDRA: Abdominal discomfort, Flatulence, Pre-existing disease, Thirst — Feeling: Good
    Free text: Stomach discomfort and gas continues but better. No extreme feeling for water but feeling of need for water which is abnormal for me. Only time I every felt need for water was during an unusual cold with muscle pain and extreme thrist pre-Sar-cov Pan
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-03-07
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-03-12
    Dose 2 — Moderna
  11. 2021-03-16
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  12. 2021-03-17
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  13. 2021-03-18
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-03-19
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-03-26
    Survey response — day 14, dose 2
    MedDRA: Axillary pain, Oedema peripheral — Feeling: Fair
    Free text: Painful right Armpit that is visibly swollen
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-04-03
    Survey response — day 21, dose 2
    MedDRA: Discomfort, Limb discomfort, Oedema peripheral — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Right Armpit still swollen causing arm arm & hand discomfort. Not as physically noticeable as last week.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-04-10
    Survey response — day 28, dose 2
    MedDRA: Pain, Peripheral swelling, Tenderness — Feeling: Fair
    Free text: Hand affected with arm movement. Right arm swelling, ache and tenderness moved from underarm to back outer arm and currently at lower outer arm. Turn and soar to touch. Left lower leg muscle flutter spasm unexpectedly.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-04-17
    Survey response — day 35, dose 2
    MedDRA: Chest pain, Pain in extremity, Peripheral swelling — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Symptoms: Arm pain and swelling because non-existing 04/14/2020. Thought reporting system was for directing me. I will check in with my pcp on covid-19 related issues. Thanks · Healthcare visit (other): May mention of pain in upper left chest . . after first shot.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-04-17
    Report sent to call center — day 35, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  20. 2021-06-14
    Survey response — 3 months, dose 2
    MedDRA: Cyanosis, Pain in extremity, Peripheral arterial occlusive disease — Feeling: Poor · 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: Fluttering in legs progressed to pain and aches in legs. Diagnosed with PAD for the first time. From time to time out of the blue having sensations in arm(s) and/or legs(s) . .
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-06-14
    Report sent to call center — 3 months, dose 2
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    1 call case(s)
  22. 2021-06-21
  23. 2021-09-10
    Survey response — 6 months, dose 2
    MedDRA: Dyspnoea, Gingival discomfort, Pain in extremity, Sensory disturbance — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Leg/thigh Pain, shortness of breath, and arm & leg sensations, unusual gum irritations ...
    MedDRA releases: 2024-11 · check-in free text available
  24. 2022-03-12
    Survey response — 12 months, dose 2
    MedDRA: Angiopathy, Pain — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit
    Free text: Vascular problems and extreme pain. . .
    MedDRA releases: 2024-11 · check-in free text available
  25. 2022-03-12
    Report sent to call center — 12 months, dose 2
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
  26. 2022-03-14
    Call successful
    Participant prefers to complete VAERS report online

Vaccinations

DoseDateManufacturerCo-administered
12021-02-12Moderna
22021-03-12Moderna

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-15

Systemic reaction (other): Extreme dry mouth and lips. Unusual constipation.

2021-02-16

Systemic reaction (other): Mild dryness of mouth and lips. Milder Constipation and gas

2021-02-17

Systemic reaction (other): Gas

Release 4 — day 7, dose 1

2021-02-21

Systemic reaction (other): Some stomach discomfort still

Release 4 — day 14, dose 1

2021-02-26

Symptoms: Stomach discomfort and gas continues but better. No extreme feeling for water but feeling of need for water which is abnormal for me. Only time I every felt need for water was during an unusual cold with muscle pain and extreme thrist pre-Sar-cov Pan cut off by CDC

Release 6 — day 14, dose 2

2021-03-26

Symptoms: Painful right Armpit that is visibly swollen

Release 6 — day 21, dose 2

2021-04-03

Symptoms: Right Armpit still swollen causing arm arm & hand discomfort. Not as physically noticeable as last week.

Release 7 — day 28, dose 2

2021-04-10

Symptoms: Hand affected with arm movement. Right arm swelling, ache and tenderness moved from underarm to back outer arm and currently at lower outer arm. Turn and soar to touch. Left lower leg muscle flutter spasm unexpectedly.

Release 7 — day 35, dose 2

2021-04-17

Symptoms: Arm pain and swelling because non-existing 04/14/2020. Thought reporting system was for directing me. I will check in with my pcp on covid-19 related issues. Thanks
Healthcare visit (other): May mention of pain in upper left chest . . after first shot.

Release 9 — 3 months, dose 2

2021-06-14

Symptoms: Fluttering in legs progressed to pain and aches in legs. Diagnosed with PAD for the first time. From time to time out of the blue having sensations in arm(s) and/or legs(s) . .

Release 9 — 6 months, dose 2

2021-09-10

Symptoms: Leg/thigh Pain, shortness of breath, and arm & leg sensations, unusual gum irritations ...

Release 11 — 12 months, dose 2

2022-03-12

Symptoms: Vascular problems and extreme 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

FieldPreferred term2021-092023-042024-11
HCVOChest pain ✓ ✓ ✓
SDAbdominal discomfort ✓ ✓ ✓
SDAngiopathy · · ✓
SDAxillary pain ✓ ✓ ✓
SDCyanosis ✓ ✓ ✓
SDDiscomfort ✓ ✓ ✓
SDDyspnoea · · ✓
SDFlatulence ✓ ✓ ✓
SDGingival discomfort · · ✓
SDLimb discomfort ✓ ✓ ✓
SDOedema peripheral ✓ ✓ ✓
SDPain ✓ ✓ ✓
SDPain in extremity ✓ ✓ ✓
SDPeripheral arterial occlusive disease ✓ ✓ ✓
SDPeripheral swelling ✓ ✓ ✓
SDPre-existing disease ✓ · ✓
SDSensory disturbance · · ✓
SDTenderness ✓ ✓ ✓
SDThirst ✓ ✓ ✓
SROAbdominal discomfort ✓ ✓ ✓
SROConstipation ✓ ✓ ✓
SRODry mouth ✓ ✓ ✓
SROFlatulence ✓ ✓ ✓
SROLip dry ✓ ✓ ✓

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