6MW-48449-16207

3 vaccinations 4 coded responses 26 check-ins 4 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 223 / VA
Registered: 2021-01-22

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

2021-01-21
Dose 1 — Moderna
2021-01-22
Registered in v-safe
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Feeling abnormal, Feeling cold, Peripheral coldness — Feeling: Fair · Fever · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: dizziness, foggy and cold hands feet and nose ice cold. Couldnt get warm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

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

Adult check-in
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-25
Dose 2 — Moderna
2021-02-25
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Headache, Joint pains

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-03-04
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-08
Survey response — day 42, dose 2
MedDRA: Basal cell carcinoma, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Basel cell carcinoma Markers for both Graves desease and Hashimoto desease

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Axillary pain, Breast pain, Mammogram, Pain in extremity, Ultrasound scan, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Horrific arm pit and breast pain. After the 2nd vaccine on 2/25/2021 through May. Had a mammogram on 4/16/2021 and then a diagnostic mammogram. Examine rendered no issues. Amscheduled for another mammogram · Healthcare visit (other): diagnostic mammogram

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-26
Survey response — 6 months, dose 2
MedDRA: Axillary pain, Breast pain, Office visit — Feeling: Good

Free text: I received the Moderna 2nd vaccine in my left arm 2/25. I had horrible pain in my left arm pit and left breast through April. Had a mammogram April 16th and diagnostic test as well. Dr believes it was due to vaccine.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-12-06
Dose 3 — Moderna
2022-02-17
Call successful
Does not wish to fill out VAERS report
2022-02-25
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-25	Moderna
3	2021-12-06	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): dizziness, foggy and cold hands feet and nose ice cold. Couldnt get warm.

Release 7 — day 42, dose 2

2021-04-08

Symptoms: Basel cell carcinoma Markers for both Graves desease and Hashimoto desease

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: Horrific arm pit and breast pain. After the 2nd vaccine on 2/25/2021 through May. Had a mammogram on 4/16/2021 and then a diagnostic mammogram. Examine rendered no issues. Amscheduled for another mammogram

Healthcare visit (other): diagnostic mammogram

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: I received the Moderna 2nd vaccine in my left arm 2/25. I had horrible pain in my left arm pit and left breast through April. Had a mammogram April 16th and diagnostic test as well. Dr believes it was due to vaccine.

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	Ultrasound scan	○	✓	○
HCVO	Unevaluable event	✓	·	✓
SD	Axillary pain	✓	·	✓
SD	Basal cell carcinoma	✓	✓	✓
SD	Breast pain	✓	✓	✓
SD	Mammogram	○	✓	○
SD	Office visit	✓	·	✓
SD	Pain in extremity	○	✓	○
SD	Pre-existing disease	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Feeling cold	✓	✓	✓
SRO	Peripheral coldness	✓	✓	✓

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