5SA-21367-42643

4 vaccinations 10 coded responses 43 check-ins 10 free-text entries 3 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 720 / AR
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-10
Dose 2 — Moderna
2021-02-10
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Tremor — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Have had tremors off and on for two days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Typical aura without headache — Feeling: Good · Headache

Free text: Silent migraine x three days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Typical aura without headache — Feeling: Good · Headache

Free text: Same silent migraine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — day 14, dose 2
Feeling: Good

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

Adult check-in
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-10
Dose 3 — Moderna
2022-02-10
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-10
Survey response — 12 months, dose 2
MedDRA: Fatigue, Rhinorrhoea, SARS-CoV-2 test negative, Sneezing — Feeling: Good

Free text: Sneezing, runny nose, tired. Four neg COVID tests

MedDRA releases: 2024-11 · check-in free text available
2022-02-14
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-21
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-04-11
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-07-01
Dose 4 — Moderna
2022-07-01
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-02
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-07-03
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-07-04
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-07-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches

Adult check-in
2022-07-07
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-07-08
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-07-15
Survey response — day 14, dose 4
MedDRA: Arthralgia, Arthropathy, Joint range of motion decreased, Tremor — Feeling: Good · Be unable to do your normal daily activities

Free text: Continued shoulder pain and limited range of motion preventing normal use. Tremor noted daily on the same arm and hand.

MedDRA releases: 2024-11 · check-in free text available
2022-07-22
Survey response — day 21, dose 4
MedDRA: Arthralgia, Joint range of motion decreased, Tremor — Feeling: Good · Be unable to do your normal daily activities

Free text: Left shoulder joint pain, prevents full range of motion. Require assistance dressing and undressing. Tremor to left hand, left elbow pain.

MedDRA releases: 2024-11 · check-in free text available
2022-07-29
Survey response — day 28, dose 4
MedDRA: Arthralgia, Tremor — Feeling: Good · Be unable to do your normal daily activities

Free text: Pain to left should persists along with left hand tremor. Provider appointment scheduled for Monday

MedDRA releases: 2024-11 · check-in free text available
2022-08-05
Survey response — day 35, dose 4
MedDRA: Arthralgia, Office visit, Tremor — Feeling: Good · 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: Continued left shoulder pain and left arm tremor. Saw physician Monday, x-ray taken. Awaiting next steps.

MedDRA releases: 2024-11 · check-in free text available
2022-08-05
Report sent to call center — day 35, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-08-08
Call 1 — Left Voicemail
2022-08-08
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-14
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-09-30
Survey response — 3 months, dose 4
MedDRA: Arthralgia, Blood pressure increased, Confusional state, Headache, Migraine, Periarthritis, Tremor, Unevaluable event, Visual impairment — 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, Emergency room or emergency department visit

Free text: Symptoms: Increased headache/migraine since July 2, intractable x 8 weeks, significant tremors, confusion, vision disturbances, should joint pain, frozen shoulder. Blood pressure bouncing around from normal to significantly high. None of this is normal. · Healthcare visit (other): MRI scheduled 10/3

MedDRA releases: 2024-11 · check-in free text available
2022-09-30
Report sent to call center — 3 months, dose 4
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 · Emergency room or emergency department visit · 1 call case(s)
2022-10-03
Call successful
Participant prefers to complete VAERS report online
2022-12-30
Survey response — 6 months, dose 4
MedDRA: Bradyphrenia, Confusional state, Heart rate irregular, Neuropathy peripheral, Office visit, Tinnitus, Tremor — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Tremor, tinnitus, confusion, irregular heart rate, neuropathy on the top of my feet and heels, slowness of thought and thought processes. · Healthcare visit (other): Neurologist

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
Report sent to call center — 6 months, dose 4
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)
2023-01-03
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-10	Moderna
3	2022-01-10	Moderna	No
4	2022-07-01	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Have had tremors off and on for two days.

2021-02-15

Systemic reaction (other): Silent migraine x three days

2021-02-16

Systemic reaction (other): Same silent migraine.

Release 11 — 12 months, dose 2

2022-02-10

Symptoms: Sneezing, runny nose, tired. Four neg COVID tests

Release 12 — day 14, dose 4

2022-07-15

Symptoms: Continued shoulder pain and limited range of motion preventing normal use. Tremor noted daily on the same arm and hand.

Release 12 — day 21, dose 4

2022-07-22

Symptoms: Left shoulder joint pain, prevents full range of motion. Require assistance dressing and undressing. Tremor to left hand, left elbow pain.

Release 12 — day 28, dose 4

2022-07-29

Symptoms: Pain to left should persists along with left hand tremor. Provider appointment scheduled for Monday

Release 12 — day 35, dose 4

2022-08-05

Symptoms: Continued left shoulder pain and left arm tremor. Saw physician Monday, x-ray taken. Awaiting next steps.

Release 12 — 3 months, dose 4

2022-09-30

Symptoms: Increased headache/migraine since July 2, intractable x 8 weeks, significant tremors, confusion, vision disturbances, should joint pain, frozen shoulder. Blood pressure bouncing around from normal to significantly high. None of this is normal.

Healthcare visit (other): MRI scheduled 10/3

Release 12 — 6 months, dose 4

2022-12-30

Symptoms: Tremor, tinnitus, confusion, irregular heart rate, neuropathy on the top of my feet and heels, slowness of thought and thought processes.

Healthcare visit (other): Neurologist

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	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Arthropathy	·	·	✓
SD	Blood pressure increased	·	·	✓
SD	Bradyphrenia	·	·	✓
SD	Confusional state	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Heart rate irregular	·	·	✓
SD	Joint range of motion decreased	·	·	✓
SD	Migraine	·	·	✓
SD	Neuropathy peripheral	·	·	✓
SD	Office visit	·	·	✓
SD	Periarthritis	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sneezing	·	·	✓
SD	Tinnitus	·	·	✓
SD	Tremor	·	·	✓
SD	Visual impairment	·	·	✓
SRO	Tremor	✓	✓	✓
SRO	Typical aura without headache	✓	✓	✓

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