6KX-22542-63749

5 vaccinations 19 coded responses 38 check-ins 18 free-text entries 10 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 916 / CA
Registered: 2021-02-26

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

2021-02-24
Dose 1 — Moderna
2021-02-26
Registered in v-safe
2021-02-26
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Joint pains, Muscle or body aches

Free text: Ni

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Swelling · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-02-28
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches

Free text: These are consistent with symptoms I had before shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · Joint pains, Muscle or body aches

Adult check-in
2021-03-03
Health check-in — day 7, dose 1
Feeling: Fair · Site: Swelling · Joint pains, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-17
Survey response — day 21, dose 1
MedDRA: Chest pain, Headache, Medical counselling, Oropharyngeal pain, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Bad sore throatHeadacheFibromyalgia Chest pain all day yesterday that did not respond to nitroglycerin · Healthcare visit (other): I consulted my cardiologists office and left a message for my doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Report sent to call center — day 21, dose 1
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)
2021-03-24
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-03-25
Dose 2 — Moderna
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Joint pains

Adult check-in
2021-04-03
Health check-in — day 7, dose 2
Feeling: Good · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-04-08
Survey response — day 14, dose 2
MedDRA: Arthralgia, Bone pain, Dyspnoea, Fatigue, Hyperhidrosis, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair

Free text: Bone pain Sweating Fatigue Joint pain Runny nose Breathing hard Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-22
Survey response — day 28, dose 2
MedDRA: Arthritis, Condition aggravated, Headache, Oropharyngeal pain, Pre-existing disease, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Sore throat and headache have come backFibromyalgia seems to be worseArthritis seems to be worse · Healthcare visit (other): Will see regular arthritis doctor for scheduled appointment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-29
Survey response — day 35, dose 2
MedDRA: Arthralgia, Blood glucose increased, Condition aggravated, Insomnia, Office visit, Pain in jaw, Pre-existing disease — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: My fibromyalgia is worseIve had feelings of being very cold and very hotMy joints hurt and I had trouble sleeping and my blood sugar was high and my jaws hurt · Healthcare visit (other): Visited dentist for jaw pain and had stretching sessions with personal trainer

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Report sent to call center — day 35, 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)
2021-05-06
Survey response — day 42, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Very bad and disabling fibromyalgia flare

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Report sent to call center — day 42, 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)
2021-06-24
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-28
Dose 3 — Moderna
2021-09-23
Survey response — 6 months, dose 2
MedDRA: Chest pain, Dyspnoea, Insomnia — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Very bad chest pain and trouble breathing and sleeping

MedDRA releases: 2024-11 · check-in free text available
2021-09-23
Report sent to call center — 6 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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-09-27
Call 3 — Could Not Reach Participant
2021-09-28
Call 3 — Left Voicemail
2021-11-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-26
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-04
Dose 4 — Moderna
2022-05-14
Health check-in — day 7, dose 4
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-18
Survey response — day 14, dose 4
MedDRA: Chills, Diplopia, Fatigue, Hot flush, Insomnia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Chills, hot flashes, double vision, fatigue, sleeplessness

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Survey response — day 21, dose 4
MedDRA: Stomatitis — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Mouth sores

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-26
Call successful
Does not wish to fill out VAERS report
2022-05-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-01
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-08
Survey response — day 35, dose 4
MedDRA: Condition aggravated, Irritability, Memory impairment, Pain, Pre-existing disease — Feeling: Fair · Be unable to work or attend school

Free text: Fibromyalgia is worse. More pain, forgetfulness, edginess

MedDRA releases: 2024-11 · check-in free text available
2022-06-15
Survey response — day 42, dose 4
MedDRA: Diplopia, Office visit, Pain, Pre-existing 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

Free text: Symptoms: Fibromyalgia pain Double vision · Healthcare visit (other): Doctor visit

MedDRA releases: 2024-11 · check-in free text available
2022-06-15
Report sent to call center — day 42, 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

1 call case(s)
2022-06-16
Call 1 — Left Voicemail
2022-06-16
Call 1 — Left Voicemail
2022-06-16
Call 1 — Left Voicemail
2022-06-16
Call 1 — Left Voicemail
2022-06-16
Call 1 — Left Voicemail
2022-06-16
Call 1 — Left Voicemail
2022-06-16
Call 1 — Left Voicemail
2022-08-03
Survey response — 3 months, dose 4
MedDRA: Diplopia, Fibromyalgia, Fungal foot infection, Fungal infection, Office visit, Pain — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bad foot fungus spreading to legs, double vision, fibromyalgia pain · Healthcare visit (other): Appointment with physician

MedDRA releases: 2024-11 · check-in free text available
2022-08-03
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 2 — Left Voicemail
2022-08-04
Call 1 — Left Voicemail
2022-11-04
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2022-11-05
Dose 5 — Moderna
2022-11-09
Survey response — days 1–6 daily, dose 5
MedDRA: Adverse reaction, Chest discomfort, Pre-existing disease — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Nausea

Free text: Not really. I frequently have same symptoms because of my health conditions . I do feel like my chest has pressure.

MedDRA releases: 2024-11 · check-in free text available
2022-11-10
Survey response — days 1–6 daily, dose 5
MedDRA: Fibromyalgia — Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body aches

Free text: Fibromyalgia but pain meds are working

MedDRA releases: 2024-11 · check-in free text available
2022-11-12
Survey response — day 7, dose 5
MedDRA: No adverse event — Feeling: Good · Site: Pain

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-11-19
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-26
Survey response — day 21, dose 5
MedDRA: Anxiety, Arthralgia, Chest discomfort, Myalgia, Nausea, Rhinorrhoea, Unevaluable event — Feeling: Poor

Free text: Running nose Chest discomfort Pain.. muscle and joint Nausea Anxiety

MedDRA releases: 2024-11 · check-in free text available
2022-12-03
Survey response — day 28, dose 5
MedDRA: Nausea, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Nausea · Healthcare visit (other): Doctors office

MedDRA releases: 2024-11 · check-in free text available
2022-12-03
Report sent to call center — day 28, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-05
Call successful
Not applicable - Accidental Reporting
2022-12-05
Call successful
Not applicable - Accidental Reporting
2022-12-05
Call successful
Not applicable - Accidental Reporting
2022-12-12
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-12-17
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-02-04
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-05-06
Survey response — 6 months, dose 5
MedDRA: COVID-19, Condition aggravated, Cough, Office visit, Pre-existing disease, Rheumatoid arthritis — 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 · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-05-06
Report sent to call center — 6 months, dose 5
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 · 1 call case(s)
2023-05-08
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	2021-02-24	Moderna
2	2021-03-25	Moderna
3	2021-08-28	Moderna	No
4	2022-05-04	Moderna	No
5	2022-11-05	Moderna	No

Call center

10 call center cases

10 successful

4 waits over 3 months for a first call

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-26

Systemic reaction (other): Ni

2021-02-28

Systemic reaction (other): These are consistent with symptoms I had before shot.

Release 5 — day 21, dose 1

2021-03-17

Symptoms: Bad sore throatHeadacheFibromyalgia Chest pain all day yesterday that did not respond to nitroglycerin

Healthcare visit (other): I consulted my cardiologists office and left a message for my doctor

Release 7 — day 14, dose 2

2021-04-08

Symptoms: Bone pain Sweating Fatigue Joint pain Runny nose Breathing hard Sore throat

Release 7 — day 28, dose 2

2021-04-22

Symptoms: Sore throat and headache have come backFibromyalgia seems to be worseArthritis seems to be worse

Healthcare visit (other): Will see regular arthritis doctor for scheduled appointment

Release 8 — day 35, dose 2

2021-04-29

Symptoms: My fibromyalgia is worseIve had feelings of being very cold and very hotMy joints hurt and I had trouble sleeping and my blood sugar was high and my jaws hurt

Healthcare visit (other): Visited dentist for jaw pain and had stretching sessions with personal trainer

Release 8 — day 42, dose 2

2021-05-06

Symptoms: Very bad and disabling fibromyalgia flare

Release 9 — 6 months, dose 2

2021-09-23

Symptoms: Very bad chest pain and trouble breathing and sleeping

Release 11 — day 14, dose 4

2022-05-18

Symptoms: Chills, hot flashes, double vision, fatigue, sleeplessness

Release 11 — day 21, dose 4

2022-05-25

Symptoms: Mouth sores

Release 11 — day 35, dose 4

2022-06-08

Symptoms: Fibromyalgia is worse. More pain, forgetfulness, edginess

Release 12 — day 42, dose 4

2022-06-15

Symptoms: Fibromyalgia pain Double vision

Healthcare visit (other): Doctor visit

Release 12 — 3 months, dose 4

2022-08-03

Symptoms: Bad foot fungus spreading to legs, double vision, fibromyalgia pain

Healthcare visit (other): Appointment with physician

Release 12 — days 1–6 daily, dose 5

2022-11-09

Systemic reaction (other): Not really. I frequently have same symptoms because of my health conditions . I do feel like my chest has pressure.

2022-11-10

Systemic reaction (other): Fibromyalgia but pain meds are working

Release 12 — day 7, dose 5

2022-11-12

Systemic reaction (other): No

Release 12 — day 21, dose 5

2022-11-26

Symptoms: Running nose Chest discomfort Pain.. muscle and joint Nausea Anxiety

Release 12 — day 28, dose 5

2022-12-03

Symptoms: Nausea

Healthcare visit (other): Doctors office

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	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Pain in jaw	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Anxiety	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Arthritis	✓	✓	✓
SD	Blood glucose increased	✓	✓	✓
SD	Bone pain	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Chills	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diplopia	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Fibromyalgia	·	·	✓
SD	Fungal foot infection	·	·	✓
SD	Fungal infection	·	·	✓
SD	Headache	✓	✓	✓
SD	Hot flush	·	·	✓
SD	Hyperhidrosis	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Irritability	·	·	✓
SD	Memory impairment	·	·	✓
SD	Myalgia	·	·	✓
SD	Nausea	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Pain in jaw	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rheumatoid arthritis	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Stomatitis	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Chest discomfort	·	·	✓
SRO	Fibromyalgia	·	·	✓
SRO	No adverse event	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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