UZ5-15070-24486

3 vaccinations 18 coded responses 28 check-ins 18 free-text entries 3 call cases

Sex: —
Age at first dose: 31-35
ZIP prefix: 857 / AZ
Registered: 2021-01-14

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

Timeline

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Survey response — day 0, dose 1
MedDRA: Tachycardia — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Mild tachycardia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Report sent to call center — day 0, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort, Chest discomfort — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Nausea

Free text: Tightness in chest, stomach upset overnight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Chest discomfort — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches

Free text: Chest tightness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Fatigue or tiredness

Adult check-in
2021-01-28
Survey response — day 14, dose 1
MedDRA: Headache, Pain in jaw — Feeling: Fair

Free text: Headache, jaw pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — day 21, dose 1
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Exhaustion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Dose 2 — Moderna
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-16
Health check-in — day 7, dose 2
Feeling: Poor · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-22
Survey response — day 14, dose 2
MedDRA: Abdominal pain, Musculoskeletal chest pain, Splenomegaly — Feeling: Fair · Be unable to do your normal daily activities

Free text: Ongoing pain in my spleen and rib cage - my spleen feels enlarged.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — day 21, dose 2
MedDRA: Vaccination site discomfort, Vaccination site pain — Feeling: Fair

Free text: Discomfort/mild pain at vaccination site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — day 28, dose 2
MedDRA: Abdominal pain — Feeling: Good

Free text: Pain off and on in spleen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-08-11
Survey response — 6 months, dose 2
MedDRA: Cardiac flutter, Chest discomfort — 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 · Emergency room or emergency department visit

Free text: Chest tightness, heart fluttering

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-11
Report sent to call center — 6 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

1 call case(s)
2021-08-12
Call 2 — Left Voicemail
2022-01-03
Dose 3 — Moderna
2022-01-03
Survey response — day 0, dose 3
MedDRA: Cardiac flutter, Chest pain, Pulmonary pain — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Chest and lung pain and fluttering through chest, heart, midback

MedDRA releases: 2024-11 · check-in free text available
2022-01-04
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal pain, Abdominal pain upper, Chest pain, Pain — Feeling: Poor · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Free text: S shooting pains in chest, back, torso, spleen

MedDRA releases: 2024-11 · check-in free text available
2022-01-05
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal pain upper, Chest pain, Pain — Feeling: Fair · Site: Pain, Swelling · Fever · Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Sharp stabbing pain in chest, torso, spleen

MedDRA releases: 2024-11 · check-in free text available
2022-01-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-01-08
Survey response — days 1–6 daily, dose 3
MedDRA: Chest pain — Feeling: Fair

Free text: chest pain off and on, sharp pinpoint pain off and on

MedDRA releases: 2024-11 · check-in free text available
2022-01-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-01-11
Health check-in — day 7, dose 3
Feeling: Fair · Abdominal pain

Adult check-in
2022-01-17
Survey response — day 14, dose 3
MedDRA: Chest pain, Dyspnoea, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Poking sharp pain throughout torso and chest in different areas. Mild shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Survey response — day 21, dose 3
MedDRA: Paraesthesia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Continued sharp poking sensations throughout entire torso and chest

MedDRA releases: 2024-11 · check-in free text available
2022-01-31
Survey response — day 28, dose 3
MedDRA: Abdominal pain upper — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sharp stabbing pain in spleen

MedDRA releases: 2024-11 · check-in free text available
2022-02-09
Survey response — day 35, dose 3
MedDRA: Respiratory tract congestion — Feeling: Good · Be unable to do your normal daily activities

Free text: Chest congestion consistently

MedDRA releases: 2024-11 · check-in free text available
2022-02-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-07-06
Survey response — 6 months, dose 3
MedDRA: Abdominal pain upper, Respiratory tract congestion, 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

Free text: poking pain in spleen, tachycardia, chest congestion

MedDRA releases: 2024-11 · check-in free text available
2022-07-06
Report sent to call center — 6 months, 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)
2022-07-07
Call 1 — Left Voicemail
2022-07-07
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-08	Moderna
3	2022-01-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-14	priority 2/3
2021-08-11	Unsuccessful
2022-07-06	Unsuccessful

Free text

Release 2 — day 0, dose 1

2021-01-14

Systemic reaction (other): Mild tachycardia

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Tightness in chest, stomach upset overnight

2021-01-16

Systemic reaction (other): Chest tightness

Release 3 — day 14, dose 1

2021-01-28

Symptoms: Headache, jaw pain

Release 3 — day 21, dose 1

2021-02-04

Symptoms: Exhaustion

Release 4 — day 14, dose 2

2021-02-22

Symptoms: Ongoing pain in my spleen and rib cage - my spleen feels enlarged.

Release 4 — day 21, dose 2

2021-03-01

Symptoms: Discomfort/mild pain at vaccination site

Release 5 — day 28, dose 2

2021-03-10

Symptoms: Pain off and on in spleen

Release 9 — 6 months, dose 2

2021-08-11

Symptoms: Chest tightness, heart fluttering

Release 10 — day 0, dose 3

2022-01-03

Systemic reaction (other): Chest and lung pain and fluttering through chest, heart, midback

Release 10 — days 1–6 daily, dose 3

2022-01-04

Systemic reaction (other): S shooting pains in chest, back, torso, spleen

2022-01-05

Systemic reaction (other): Sharp stabbing pain in chest, torso, spleen

2022-01-08

Systemic reaction (other): chest pain off and on, sharp pinpoint pain off and on

Release 10 — day 14, dose 3

2022-01-17

Symptoms: Poking sharp pain throughout torso and chest in different areas. Mild shortness of breath

Release 11 — day 21, dose 3

2022-01-24

Symptoms: Continued sharp poking sensations throughout entire torso and chest

Release 11 — day 28, dose 3

2022-01-31

Symptoms: Sharp stabbing pain in spleen

Release 11 — day 35, dose 3

2022-02-09

Symptoms: Chest congestion consistently

Release 12 — 6 months, dose 3

2022-07-06

Symptoms: poking pain in spleen, tachycardia, chest congestion

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	Abdominal pain	✓	✓	✓
SD	Abdominal pain upper	·	·	✓
SD	Cardiac flutter	✓	·	✓
SD	Chest discomfort	✓	·	✓
SD	Chest pain	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Musculoskeletal chest pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Pain in jaw	✓	✓	✓
SD	Paraesthesia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Splenomegaly	✓	✓	✓
SD	Tachycardia	·	·	✓
SD	Vaccination site discomfort	✓	✓	✓
SD	Vaccination site pain	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Abdominal pain	·	·	✓
SRO	Abdominal pain upper	·	·	✓
SRO	Cardiac flutter	·	·	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Chest pain	·	·	✓
SRO	Pain	·	·	✓
SRO	Pulmonary pain	·	·	✓
SRO	Tachycardia	✓	✓	✓

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