PLT-22763-35131

3 vaccinations 13 coded responses 29 check-ins 13 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 503 / IA
Registered: 2021-03-29

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

ARZ-25191-51960 Adult relative or friend · Male · 2021-10-19

SFA-11922-24138 Adult relative or friend · Female · 2021-10-19

Timeline

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

2021-03-23
Dose 1 — Moderna
2021-03-29
Registered in v-safe
2021-03-29
Survey response — days 1–6 daily, dose 1
MedDRA: Oral mucosal eruption, Pharyngeal swelling, Stomatitis, Swelling, Tongue eruption, Tongue ulceration — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-30
Survey response — 7 day, dose 1
MedDRA: Oropharyngeal pain — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-06
Survey response — 14 day, dose 1
MedDRA: Dyspnoea, Fibrin D dimer increased, Muscle spasms, Nodule, Oropharyngeal pain, Thrombosis, Wheezing — Feeling: Poor · Be unable to work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-13
Health check-in — 21 day, dose 1
Feeling: Fair

Adult check-in
2021-04-20
Dose 2 — Moderna
2021-04-20
Health check-in — 0 day, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work

Adult check-in
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea, Oropharyngeal pain — Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Dyspnoea, Oropharyngeal pain — Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness · Be unable to work

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-27
Survey response — 7 day, dose 2
MedDRA: Brain fog, Dizziness, Dyspnoea — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-05
Health check-in — 14 day, dose 2
Feeling: Fair

Adult check-in
2021-05-11
Survey response — 21 day, dose 2
MedDRA: Dyspnoea, Palpitations — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-18
Health check-in — 28 day, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-06-01
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2021-07-20
Survey response — 3 month, dose 2
MedDRA: Atrial tachycardia, Essential hypertension, Sinus tachycardia — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

MedDRA releases: 2024-11 · check-in answers available
2021-07-20
Report sent to call center — 3 month, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-27
Call 1 — Could Not Reach Participant
2021-07-31
Call 2 — Could Not Reach Participant
2021-10-19
Health check-in — 6 month, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Headache, Rash, not including the immediate area around the injection site

Adult check-in
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Oropharyngeal pain — Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

MedDRA releases: 2024-11 · check-in answers available
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Oropharyngeal pain — Feeling: Good · Headache, Fatigue or tiredness, Nausea

MedDRA releases: 2024-11 · check-in answers available
2021-11-02
Survey response — 7 day, dose 3
MedDRA: Flatulence — Feeling: Good · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11 · check-in answers available
2021-11-02
Report sent to call center — 7 day, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-03
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-09
Health check-in — 14 day, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — 21 day, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — 28 day, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — 35 day, dose 3
Feeling: Good

Adult check-in
2021-12-09
Survey response — 42 day, dose 3
MedDRA: Nasal ulcer — Feeling: Good

MedDRA releases: 2024-11 · check-in answers available
2022-01-25
Health check-in — 3 month, dose 3
Feeling: Fair

Adult check-in
2022-04-26
Survey response — 6 month, dose 3
MedDRA: Arthralgia, Pain — Feeling: Good

MedDRA releases: 2024-11 · check-in answers available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-23	Moderna
2	2021-04-20	Moderna
3	2021-10-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-20	Successful	Participant prefers to complete VAERS report online
2021-11-02	Successful 2021-11-03	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 6

Systemic reaction (other): Swollen throat. Swelling behind my ears. Rash/Sores in the back of my mouth and tongue.

Systemic reaction (other): Throat hurts,

Release 7

Symptoms: Wheezing and hard to breathe but clear lungsSore throat High d-dimmer but couldnt find a clot in my leg that had a knot in it after a muscle cramp.

Systemic reaction (other): Soar throat, short of breath easy

Release 8

Systemic reaction (other): Dizziness, sore throat, short of breath easy

Systemic reaction (other): Dizzy, Short of breath, and brain fog.

Symptoms: Racing heart, short of breath

Release 9

Symptoms: Ectopic atrial tachycardiaInappropriate sinus tachycardia Essential Hypertension

Release 10

Systemic reaction (other): Sore throat

Systemic reaction (other): Sore Throat

Systemic reaction (other): Lots gas

Symptoms: Sores on the inside of nose

Release 11

Symptoms: Achy joints. Like anywhere to bones come together and the more I move it the more it can hurt.

Free-text releases are not linked to a specific 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	Arthralgia	·	·	✓
SD	Atrial tachycardia	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Essential hypertension	·	·	✓
SD	Fibrin D dimer increased	✓	·	✓
SD	Muscle spasms	✓	✓	✓
SD	Nasal ulcer	·	·	✓
SD	Nodule	✓	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Palpitations	✓	✓	✓
SD	Sinus tachycardia	·	·	✓
SD	Thrombosis	○	✓	○
SD	Wheezing	✓	✓	✓
SRO	Brain fog	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Flatulence	·	·	✓
SRO	Oral mucosal eruption	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pharyngeal swelling	✓	✓	✓
SRO	Stomatitis	✓	✓	✓
SRO	Swelling	✓	✓	✓
SRO	Tongue eruption	✓	✓	✓
SRO	Tongue ulceration	✓	✓	✓

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