X6X-71910-59336

2 vaccinations 8 coded responses 26 check-ins 8 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 120 / NY
Registered: 2021-03-07

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-03-07
Registered in v-safe
2021-03-08
Dose 1 — Moderna
2021-03-08
Health check-in — 0 day, dose 1
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — 7 day, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-03-29
Health check-in — 21 day, dose 1
Feeling: Fair

Adult check-in
2021-04-05
Dose 2 — Moderna
2021-04-05
Survey response — 0 day, dose 2
MedDRA: Arthralgia, Myalgia — Feeling: Good · Site: Pain · Muscle or body aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Nervousness — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-12
Health check-in — 7 day, dose 2
Feeling: Good · None

Adult check-in
2021-04-19
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-04-26
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-05-03
Survey response — 28 day, dose 2
MedDRA: Arthralgia, Asthenia, Dyspnoea, Office visit, Palpitations — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-03
Report sent to call center — 28 day, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-10
Survey response — 35 day, dose 2
MedDRA: Asthenia, Diarrhoea, Dyspnoea, Nausea, Office visit, Palpitations — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-10
Report sent to call center — 35 day, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Survey response — 42 day, dose 2
MedDRA: Abdominal distension, Arthralgia, Decreased appetite, Diarrhoea, Dyspnoea, Fatigue, Office visit, Palpitations — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-17
Report sent to call center — 42 day, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-21
Call 1 — Could Not Reach Participant
2021-07-06
Survey response — 3 month, dose 2
MedDRA: Arthralgia, Groin pain, Mobility decreased, Myalgia, Office visit, Pelvic pain — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-07-06
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)
2021-07-09
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-04
Survey response — 6 month, dose 2
MedDRA: Arthralgia, C-reactive protein abnormal, Diarrhoea, Full blood count abnormal, Laboratory test abnormal, Red blood cell sedimentation rate increased, Unevaluable event — Feeling: Poor · 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
2021-10-04
Report sent to call center — 6 month, dose 2
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 · 1 call case(s)
2021-10-04
Call 1 — Left Voicemail
2022-04-05
Survey response — 12 month, dose 2
MedDRA: Blood test abnormal, Inflammatory marker increased, Polymyalgia rheumatica, Pre-existing disease — 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
2022-04-05
Report sent to call center — 12 month, dose 2
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 · 1 call case(s)
2022-04-06
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-08	Moderna
2	2021-04-05	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-05-03	Unsuccessful
2021-05-10	Unsuccessful
2021-05-17	Unsuccessful
2021-07-06	Successful 2021-07-09	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-04	Unsuccessful
2022-04-05	Unsuccessful

Free text

Release 6

Systemic reaction (other): Muscle and joint pain is a regular occurrence for me

Release 7

Systemic reaction (other): Very shaky

Release 8

Symptoms: Weakness joint pain shortness breath and palpitations

Healthcare visit (other): Appt Thursday office

Symptoms: Have had daily palpitations since 4/26. Weak SOB intermittent diarrhea and nausea.

Healthcare visit (other): Gastroenterologist and cardiologist

Symptoms: Fatigue and joint pain continue shortness breath and palpitations. Loose stools poor appetite bloating

Healthcare visit (other): Office cardiology and 48 hr monitor

Release 9

Symptoms: Severe hip pelvis and groin pain in bed. Pain upper outer thigh muscle as well. Started on April 27 last Moderna April 5. This has persisted and is anew problem for me. When up and about better but difficulty getting up from sitting.

Healthcare visit (other): Family MD and Orthopedic MD

Symptoms: Persistent diarrhea, extensive increased joint pain, changes in CBC H&H inflammation markers CRP, SedRate elevated. Ongoing testing.

Healthcare visit (other): Endoscopy extensive lab work CT MRI pendingEnterography small Howell and pelvis

Release 11

Symptoms: PMR sudden diagnosis. I am ANegative and had four miscarriages related to EBF as a young woman. Thesymtomsbegan after full vaccination. On prednisone severe changes in blood work inflammatory markers sky high

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
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
SD	Abdominal distension	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Blood test abnormal	·	·	✓
SD	C-reactive protein abnormal	·	·	✓
SD	Decreased appetite	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Full blood count abnormal	·	·	✓
SD	Groin pain	✓	✓	✓
SD	Inflammatory marker increased	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Mobility decreased	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Palpitations	✓	✓	✓
SD	Pelvic pain	✓	✓	✓
SD	Polymyalgia rheumatica	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Red blood cell sedimentation rate increased	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Nervousness	✓	✓	✓

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