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UPS-16252-88378

3 vaccinations 4 coded responses 19 check-ins 4 free-text entries 1 call case
Sex
Female
Age at first dose
46-50
ZIP prefix
087 / NJ
Registered
2021-04-11
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino
Registered dependents
65Y-38217-53442 Child or adolescent in my care · Female · 2022-05-12

Timeline

  1. 2021-04-07
    Dose 1 — Moderna
  2. 2021-04-11
    Registered in v-safe
  3. 2021-04-11
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness, Nausea
    Adult check-in
  4. 2021-04-12
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Joint pains
    Adult check-in
  5. 2021-04-14
    Health check-in — day 7, dose 1
    Feeling: Poor · Site: Pain · Headache, Joint pains, Fatigue or tiredness, Nausea
    Adult check-in
  6. 2021-04-21
    Health check-in — day 14, dose 1
    Feeling: Fair
    Adult check-in
  7. 2021-04-28
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  8. 2021-05-07
    Health check-in — day 28, dose 1
    Feeling: Fair
    Adult check-in
  9. 2021-05-12
    Dose 2 — Moderna
  10. 2021-05-12
    Health check-in — day 0, dose 2
    Feeling: Fair · Headache
    Adult check-in
  11. 2021-05-13
    Survey response — days 1–6 daily, dose 2
    MedDRA: Hot flush — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Fatigue or tiredness
    Free text: Hot flashes
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-05-14
    Survey response — days 1–6 daily, dose 2
    MedDRA: Axillary pain, Chest pain, Injection site pain, Neck pain, Pain in extremity, Tenderness — Feeling: Fair · Site: Pain, Swelling · Fever · Joint pains, Muscle or body aches
    Free text: The site pain was very painful yesterday as well as my entire arm -shoulder to wrist. My opposite arm was tender as well for some strange reason. But today only hurts from the elbow up but goes into my chest and into my arm pit. Also sore neck.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-05-15
    Survey response — days 1–6 daily, dose 2
    MedDRA: Axillary pain, Chest pain — Feeling: Good · Site: Pain · Muscle or body aches
    Free text: Pain in my armpit and into chest on the injection site side.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-05-16
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Joint pains
    Adult check-in
  15. 2021-05-19
    Health check-in — day 7, dose 2
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  16. 2021-05-26
    Health check-in — day 14, dose 2
    Feeling: Fair
    Adult check-in
  17. 2021-06-02
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-06-09
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  19. 2021-06-16
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-06-23
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-11-17
    Dose 3 — Moderna
  22. 2022-05-12
    Survey response — 12 months, dose 2
    MedDRA: COVID-19, Cough, Dyspnoea, Fatigue, Nasal congestion — 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
    Free text: Covid positive. Shortness of breath. Coughing. Nasal congestion. Fatigue.
    MedDRA releases: 2024-11 · check-in free text available
  23. 2022-05-12
    Report sent to call center — 12 months, dose 2
    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)
  24. 2022-05-13
    Call successful
    Does not wish to fill out VAERS report
  25. 2022-05-18
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-04-07Moderna
22021-05-12Moderna
32021-11-17Moderna No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-13

Systemic reaction (other): Hot flashes

2021-05-14

Systemic reaction (other): The site pain was very painful yesterday as well as my entire arm -shoulder to wrist. My opposite arm was tender as well for some strange reason. But today only hurts from the elbow up but goes into my chest and into my arm pit. Also sore neck.

2021-05-15

Systemic reaction (other): Pain in my armpit and into chest on the injection site side.

Release 11 — 12 months, dose 2

2022-05-12

Symptoms: Covid positive. Shortness of breath. Coughing. Nasal congestion. Fatigue.

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

FieldPreferred term2021-092023-042024-11
SDCough · · ✓
SDCOVID-19 · · ✓
SDDyspnoea · · ✓
SDFatigue · · ✓
SDNasal congestion · · ✓
SROAxillary pain ✓ ✓ ✓
SROChest pain ✓ ✓ ✓
SROHot flush ✓ ✓ ✓
SROInjection site pain ✓ ✓ ✓
SRONeck pain ✓ ✓ ✓
SROPain in extremity ✓ ✓ ✓
SROTenderness ✓ ✓ ✓

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