LDC-24390-00015

4 vaccinations 8 coded responses 40 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 925 / CA
Registered: 2021-01-09

Relationship: Self
Race: White
Ethnicity: N/A

Registered dependents

XPZ-23146-87464 Child or adolescent in my care · Male · 2021-11-23

Timeline

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

2021-01-09
Registered in v-safe
2021-01-09
Dose 1 — Moderna
2021-01-09
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Nausea

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-14
Health check-in — days 1–6 daily, 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 — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-05
Dose 2 — Moderna
2021-02-05
Survey response — day 0, dose 2
MedDRA: Feeling hot, Immediate post-injection reaction, Swelling face — Feeling: Fair · Site: Pain · Headache, Diarrhea

Free text: 5-10 min after the injection, my left cheek and under my eye felt hot and slightly swollen. It improved after an hour.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Lip disorder — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Lips slothing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Vertigo — Feeling: Poor · Site: Pain · Chills, Headache, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities

Free text: Vertigo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Vertigo — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Vertigo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Chills, Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-02-12
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness, Nausea

Adult check-in
2021-02-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-19
Survey response — day 42, dose 2
MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair

Free text: Congestion sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Health check-in — 3 months, dose 2
Feeling: Good

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

Adult check-in
2021-11-05
Dose 3 — Moderna
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-12
Health check-in — day 7, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-19
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-26
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-17
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-04
Survey response — 3 months, dose 3
MedDRA: Arthritis, COVID-19 — Feeling: Good · Be unable to do your normal daily activities

Free text: Arthritis post Covid

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Survey response — 6 months, dose 3
MedDRA: Abortion spontaneous, COVID-19 — Feeling: Good · 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: Miscarriage. Covid

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
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)
2022-05-10
Call 2 — Left Voicemail
2022-10-21
Dose 4 — Moderna
2022-10-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-10-27
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
2022-10-28
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school

Adult check-in
2022-11-06
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-13
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-11-18
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-12-02
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-01-20
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-04-23
Survey response — 6 months, dose 4
MedDRA: Pelvic congestion — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-04-23
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-04-24
Call 1 — Requested Callback
2023-04-25
Call 1 — Left Voicemail
2023-04-25
Call 2 — Left Voicemail
2023-04-25
Callback requested for
06:30PM ET

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-09	Moderna
2	2021-02-05	Moderna
3	2021-11-05	Moderna	No
4	2022-10-21	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-06	Unsuccessful
2023-04-23	Unsuccessful

Free text

Release 3 — day 0, dose 2

2021-02-05

Systemic reaction (other): 5-10 min after the injection, my left cheek and under my eye felt hot and slightly swollen. It improved after an hour.

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): Lips slothing

2021-02-08

Systemic reaction (other): Vertigo

2021-02-09

Systemic reaction (other): Vertigo

Release 5 — day 42, dose 2

2021-03-19

Symptoms: Congestion sore throat

Release 11 — 3 months, dose 3

2022-02-04

Symptoms: Arthritis post Covid

Release 11 — 6 months, dose 3

2022-05-06

Symptoms: Miscarriage. Covid

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
SD	Abortion spontaneous	·	·	✓
SD	Arthritis	·	·	✓
SD	COVID-19	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pelvic congestion	·	·	✓
SD	Respiratory tract congestion	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Lip disorder	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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