RKL-78569-64238

4 vaccinations 7 coded responses 36 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 145 / NY
Registered: 2021-03-07

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

Registered dependents

BUQ-27939-75081 Child or adolescent in my care · Male · 2022-06-29

REN-94475-35315 Child or adolescent in my care · Male · 2023-02-17

Timeline

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

2021-02-05
Dose 1 — Moderna
2021-03-05
Dose 2 — Moderna
2021-03-07
Registered in v-safe
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Mild swelling of gland in neck on side of injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Swelling of gland on side of neck/shoulder that shot was administered.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-04
Survey response — 3 months, dose 2
MedDRA: Abortion spontaneous — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Pregnancy and then miscarriage

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-08
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-05
Dose 3 — Moderna
2021-11-05
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Mild Swelling of lymph node near collar bone on side of injection.

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain · Headache

Free text: Swelling of lymph node near collar bone on side of injection site.

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-11-12
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-20
Survey response — day 14, dose 3
MedDRA: Bladder catheterisation, Urinary retention — Feeling: Good · 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: Not sure if related but I was retaining urine and needed a Foley catheter inserted.

MedDRA releases: 2024-11 · check-in free text available
2021-11-20
Report sent to call center — day 14, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-23
Call 1 — Left Voicemail
2021-11-28
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
2021-12-10
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-18
Health check-in — day 42, dose 3
Feeling: Good

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

Free text: I had covid 19 in mid January.

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-24
Dose 4 — Moderna
2022-09-24
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-09-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-09-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-09-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-10-08
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-17
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-10-24
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-03
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-30
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-02-17
Health check-in — days 1–6 daily, dose 1, under 3
Feeling: Fair · Irritability/crying, Loss of appetite

Under 3 check-in
2023-03-25
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-11-05	Moderna	No
4	2022-09-24	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-04	Successful 2021-06-08	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-20	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-07

Systemic reaction (other): Mild swelling of gland in neck on side of injection.

2021-03-08

Systemic reaction (other): Swelling of gland on side of neck/shoulder that shot was administered.

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: Pregnancy and then miscarriage

Release 10 — days 1–6 daily, dose 3

2021-11-07

Systemic reaction (other): Mild Swelling of lymph node near collar bone on side of injection.

2021-11-08

Systemic reaction (other): Swelling of lymph node near collar bone on side of injection site.

Release 10 — day 14, dose 3

2021-11-20

Symptoms: Not sure if related but I was retaining urine and needed a Foley catheter inserted.

Release 11 — 3 months, dose 3

2022-02-04

Symptoms: I had covid 19 in mid January.

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	Bladder catheterisation	·	·	✓
SD	COVID-19	·	·	✓
SD	Urinary retention	·	·	✓
SRO	Lymphadenopathy	✓	✓	✓

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