65C-18577-82378

4 vaccinations 9 coded responses 29 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 208 / MD
Registered: 2021-03-28

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

2021-03-28
Registered in v-safe
2021-03-28
Dose 1 — Moderna
2021-03-28
Survey response — day 0, dose 1
MedDRA: Neck pain — Feeling: Good · Site: Pain

Free text: Sore neck on side of injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-20
Survey response — day 21, dose 1
MedDRA: Abdominal pain upper, Diarrhoea — Feeling: Good · Be unable to do your normal daily activities

Free text: Diarrhea and stomach cramping/pain - alleviated in a day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Dose 2 — Moderna
2021-04-25
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Breast pain, Intermenstrual bleeding — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Breast pain - burning sensation. Also had spotting hours after shot but nothing since (period expected - wondering if that or now cut short)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — days 1–6 daily, dose 2
MedDRA: Breast pain — Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Burning pain in left breast

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · None

Adult check-in
2021-05-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-11-26
Dose 3 — Moderna
2021-11-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches

Adult check-in
2021-12-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2021-12-03
Health check-in — day 7, dose 3
Feeling: Good · Site: Itching · Muscle or body aches

Adult check-in
2021-12-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-27
Survey response — 6 months, dose 3
MedDRA: Malaise, Pre-existing disease, SARS-CoV-2 test negative — 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: Thought I had covid. Tested negative. Suspect it is allergies.

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Report sent to call center — 6 months, dose 3
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)
2022-05-31
Call 1 — Left Voicemail
2022-08-14
Dose 4 — Moderna
2022-08-15
Survey response — days 1–6 daily, dose 4
MedDRA: Back pain — Feeling: Poor · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Lower back pain

MedDRA releases: 2024-11 · check-in free text available
2022-08-17
Survey response — days 1–6 daily, dose 4
MedDRA: Injection site pain, Injection site rash, Injection site swelling — Feeling: Good · Site: Pain, Redness, Swelling · Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Rash with swelling and pain appears to be below the injection site

MedDRA releases: 2024-11 · check-in free text available
2022-08-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Redness · None

Adult check-in
2022-08-19
Survey response — days 1–6 daily, dose 4
MedDRA: Arthralgia, Pain in extremity — Feeling: Good · Site: Pain · Joint pains

Free text: Left Elbow and forearm (arm that received injection) ache

MedDRA releases: 2024-11 · check-in free text available
2022-09-11
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2023-02-14
Survey response — 6 months, dose 4
MedDRA: Office visit, Pregnancy — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-02-14
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2023-02-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-28	Moderna
2	2021-04-25	Moderna
3	2021-11-26	Moderna	No
4	2022-08-14	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-27	Successful 2023-02-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-14	Successful 2023-02-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 6 — day 0, dose 1

2021-03-28

Systemic reaction (other): Sore neck on side of injection.

Release 7 — day 21, dose 1

2021-04-20

Symptoms: Diarrhea and stomach cramping/pain - alleviated in a day

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): Breast pain - burning sensation. Also had spotting hours after shot but nothing since (period expected - wondering if that or now cut short)

2021-04-27

Systemic reaction (other): Burning pain in left breast

Release 11 — 6 months, dose 3

2022-05-27

Symptoms: Thought I had covid. Tested negative. Suspect it is allergies.

Release 12 — days 1–6 daily, dose 4

2022-08-15

Systemic reaction (other): Lower back pain

2022-08-17

Systemic reaction (other): Rash with swelling and pain appears to be below the injection site

2022-08-19

Systemic reaction (other): Left Elbow and forearm (arm that received injection) ache

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	Abdominal pain upper	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Malaise	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pregnancy	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Back pain	·	·	✓
SRO	Breast pain	✓	✓	✓
SRO	Injection site pain	·	·	✓
SRO	Injection site rash	·	·	✓
SRO	Injection site swelling	·	·	✓
SRO	Intermenstrual bleeding	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Pain in extremity	·	·	✓

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