XLZ-90487-37791
4 vaccinations
6 coded responses
14 check-ins
6 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 26-30
- ZIP prefix
- 660 / KS
- Registered
- 2022-11-07
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-09
Dose 1 — Moderna
-
2021-04-06
Dose 2 — Moderna
-
2021-12-10
Dose 3 — Moderna
-
2022-11-07
Registered in v-safe
-
2022-11-07
Dose 4 — Moderna
- 2022-11-07
-
2022-11-08
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activitiesAdult check-in
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2022-11-09
Survey response — days 1–6 daily, dose 4MedDRA: Decreased appetite, Lymph node pain — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, NauseaFree text: Less appetite; lymph node pain in armpit on side of of injectionMedDRA releases: 2024-11 · check-in free text available
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2022-11-10
Survey response — days 1–6 daily, dose 4MedDRA: Axillary pain, Disturbance in attention, Dizziness, Mental impairment, Oral herpes — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Dizziness, coldsore, pain in the armpit, trouble thinking/concentratingMedDRA releases: 2024-11 · check-in free text available
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2022-11-11
Survey response — days 1–6 daily, dose 4MedDRA: Disturbance in attention, Gingival bleeding, Lymphadenopathy, Oral herpes, Pain in jaw — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Trouble concentrating; pain in my jaw like tmj; swollen lymph nodes; bleeding gums, 15 cold sores on my lips that formed 3 big ones, and cold sores in my mouth; I've become a cold sore monster lolMedDRA releases: 2024-11 · check-in free text available
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2022-11-11
Report sent to call center — days 1–6 daily, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-11-13
Survey response — days 1–6 daily, dose 4MedDRA: Gingival swelling, Oral herpes — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Many cold sores on lips and in mouth and roof of mouth. Swollen gums.MedDRA releases: 2024-11 · check-in free text available
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2022-11-14
Survey response — day 7, dose 4MedDRA: Gingival pain, Lymph node pain, Oral herpes, Pain in jaw — Feeling: Good · Headache, Fatigue or tirednessFree text: Cold sores; gum pain; jaw pain from lymph nodesMedDRA releases: 2024-11 · check-in free text available
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2022-11-14
Call successfulCompleted over the phone
- 2022-11-21
- 2022-11-28
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2022-12-05
Survey response — day 28, dose 4MedDRA: Fatigue, Nausea, Oropharyngeal pain — Feeling: FairFree text: Sour throat; nausea; tired; I don't think it's related to the vaccineMedDRA releases: 2024-11 · check-in free text available
- 2022-12-12
- 2022-12-19
- 2023-02-06
- 2023-05-08
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-09 | Moderna | No |
| 2 | 2021-04-06 | Moderna | No |
| 3 | 2021-12-10 | Moderna | No |
| 4 | 2022-11-07 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-11-11 | Successful 2022-11-14 |
Completed over the phone |
Free text
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Less appetite; lymph node pain in armpit on side of of injection
Systemic reaction (other): Dizziness, coldsore, pain in the armpit, trouble thinking/concentrating
Systemic reaction (other): Trouble concentrating; pain in my jaw like tmj; swollen lymph nodes; bleeding gums, 15 cold sores on my lips that formed 3 big ones, and cold sores in my mouth; I've become a cold sore monster lol
Systemic reaction (other): Many cold sores on lips and in mouth and roof of mouth. Swollen gums.
Release 12 — day 7, dose 4
Systemic reaction (other): Cold sores; gum pain; jaw pain from lymph nodes
Release 12 — day 28, dose 4
Symptoms: Sour throat; nausea; tired; I don't think it's related to the vaccine
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 | Fatigue | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SRO | Axillary pain | · | · | ✓ |
| SRO | Decreased appetite | · | · | ✓ |
| SRO | Disturbance in attention | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Gingival bleeding | · | · | ✓ |
| SRO | Gingival pain | · | · | ✓ |
| SRO | Gingival swelling | · | · | ✓ |
| SRO | Lymph node pain | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
| SRO | Mental impairment | · | · | ✓ |
| SRO | Oral herpes | · | · | ✓ |
| SRO | Pain in jaw | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release