9JU-10683-84153

4 vaccinations 10 coded responses 39 check-ins 10 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 782 / TX
Registered: 2021-02-04

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-07
Dose 1 — Moderna
2021-02-03
Dose 2 — Moderna
2021-02-04
Registered in v-safe
2021-02-04
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
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-10
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-17
Survey response — day 14, dose 2
MedDRA: Injection site erythema, Injection site pain, Injection site pruritus — Feeling: Good

Free text: I had some residual soreness, itching, and redness at the injection site for another 24 hrs after my last check in. However, this was my only symptom.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-03
Survey response — day 28, dose 2
MedDRA: Migraine — Feeling: Good · Be unable to do your normal daily activities

Free text: Migraine in one day requiring Nurtec to treat it but I have these periodically and do not think it is related at all to the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-05
Survey response — 3 months, dose 2
MedDRA: Migraine, Pre-existing disease — Feeling: Good

Free text: Significant increase in migraine intensity and frequency, likely unrelated to vaccination.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-04
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-27
Dose 3 — Moderna
2021-08-27
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-08-28
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-08-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache

Adult check-in
2021-09-01
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: Mild pain in lymph nodes under armpit of same arm as injection site

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-09-05
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain, Redness, Itching · None

Adult check-in
2021-09-10
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-09-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-09-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-08
Survey response — day 42, dose 3
MedDRA: Asthma, Environmental exposure, Infection, Nasopharyngitis, Pre-existing disease, SARS-CoV-2 test negative — 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

Free text: Asthma exacerbation following infection with standard cold virus (tested COVID-19 negative) and concurrent poor air quality alert days requiring prednisone and nebulizer treatments.

MedDRA releases: 2024-11 · check-in free text available
2021-10-08
Report sent to call center — day 42, dose 3
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)
2021-10-13
Call 1 — Left Voicemail
2021-10-29
Call 2 — Left Voicemail
2021-11-26
Survey response — 3 months, dose 3
MedDRA: Office visit, Thrombophlebitis — 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: Symptoms: Thrombophlebitis in posterior tibial vein · Healthcare visit (other): Ultrasound, Doppler imaging at outpatient imaging facility

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Report sent to call center — 3 months, dose 3
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)
2021-11-29
Call successful
Participant prefers to complete VAERS report online
2022-02-25
Survey response — 6 months, dose 3
MedDRA: Asthma, COVID-19, Pre-existing disease — 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: COVID + on 01/27/22 which led to severe asthma exacerbation

MedDRA releases: 2024-11 · check-in free text available
2022-02-25
Report sent to call center — 6 months, dose 3
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)
2022-03-01
Call 1 — Left Voicemail
2022-03-07
Dose 4 — Moderna
2022-03-08
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2022-03-09
Survey response — days 1–6 daily, dose 4
MedDRA: Lymphoedema — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Notable lymphoedema (approximately 5-7 cm) under arm that booster was given

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
Survey response — days 1–6 daily, dose 4
MedDRA: Axillary pain, Lymphoedema — Feeling: Good · Site: Pain, Swelling

Free text: Lymphedema and soreness along armpit area

MedDRA releases: 2024-11 · check-in free text available
2022-03-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-03-14
Survey response — day 7, dose 4
MedDRA: Lymphoedema — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Please note: Lymphedema reported on previous days may have been due to booster being administered into the triceps muscle which drained into the axial-adjacent lymph nodes; previous injections were higher up in the deltoid above the axial lymph.

MedDRA releases: 2024-11 · check-in free text available
2022-03-28
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-04-11
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-04-18
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-06-08
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-05
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-03-09
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-03	Moderna
3	2021-08-27	Moderna	No
4	2022-03-07	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 4 — day 14, dose 2

2021-02-17

Symptoms: I had some residual soreness, itching, and redness at the injection site for another 24 hrs after my last check in. However, this was my only symptom.

Release 5 — day 28, dose 2

2021-03-03

Symptoms: Migraine in one day requiring Nurtec to treat it but I have these periodically and do not think it is related at all to the vaccine.

Release 8 — 3 months, dose 2

2021-05-05

Symptoms: Significant increase in migraine intensity and frequency, likely unrelated to vaccination.

Release 9 — days 1–6 daily, dose 3

2021-09-01

Systemic reaction (other): Mild pain in lymph nodes under armpit of same arm as injection site

Release 10 — day 42, dose 3

2021-10-08

Symptoms: Asthma exacerbation following infection with standard cold virus (tested COVID-19 negative) and concurrent poor air quality alert days requiring prednisone and nebulizer treatments.

Release 10 — 3 months, dose 3

2021-11-26

Symptoms: Thrombophlebitis in posterior tibial vein

Healthcare visit (other): Ultrasound, Doppler imaging at outpatient imaging facility

Release 11 — 6 months, dose 3

2022-02-25

Symptoms: COVID + on 01/27/22 which led to severe asthma exacerbation

Release 11 — days 1–6 daily, dose 4

2022-03-09

Systemic reaction (other): Notable lymphoedema (approximately 5-7 cm) under arm that booster was given

2022-03-11

Systemic reaction (other): Lymphedema and soreness along armpit area

Release 11 — day 7, dose 4

2022-03-14

Systemic reaction (other): Please note: Lymphedema reported on previous days may have been due to booster being administered into the triceps muscle which drained into the axial-adjacent lymph nodes; previous injections were higher up in the deltoid above the axial lymph.

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	Asthma	·	·	✓
SD	COVID-19	·	·	✓
SD	Environmental exposure	·	·	✓
SD	Infection	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Thrombophlebitis	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Lymphadenopathy	✓	·	✓
SRO	Lymphoedema	·	·	✓

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