XY4-33336-59236

3 vaccinations 16 coded responses 41 check-ins 16 free-text entries 4 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 330 / FL
Registered: 2021-03-17

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

Timeline

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

2021-03-17
Registered in v-safe
2021-03-17
Dose 1 — Moderna
2021-03-17
Survey response — 0 day, dose 1
MedDRA: Feeling hot — Feeling: Good · Site: Pain · Fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Chills, Diarrhea

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Chills

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-03-24
Health check-in — 7 day, dose 1
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-03-31
Health check-in — 14 day, dose 1
Feeling: Good

Adult check-in
2021-04-07
Survey response — 21 day, dose 1
MedDRA: Fatigue — Feeling: Fair

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-14
Dose 2 — Moderna
2021-04-14
Health check-in — 0 day, dose 2
Feeling: Good · None

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-04-16
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-17
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased — Feeling: Good · Site: Pain, Redness, Swelling, Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-04-21
Health check-in — 7 day, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-28
Survey response — 14 day, dose 2
MedDRA: Somnolence — Feeling: Good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-05
Health check-in — 21 day, dose 2
Feeling: Good

Adult check-in
2021-05-12
Survey response — 28 day, dose 2
MedDRA: Headache, Nasopharyngitis, Rhinorrhoea, Sneezing — Feeling: Poor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
2021-05-19
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-05-26
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2021-07-15
Survey response — 3 month, dose 2
MedDRA: Arthralgia, Bursitis, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

MedDRA releases: 2021-09,2024-11 · check-in answers available
2021-07-15
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)
2021-07-23
Call 2 — Left Voicemail
2021-10-13
Survey response — 6 month, dose 2
MedDRA: Bursitis, Herpes zoster — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11 · check-in answers available
2021-10-13
Report sent to call center — 6 month, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-15
Call 2 — Left Voicemail
2021-11-22
Dose 3 — Moderna
2021-11-22
Health check-in — 0 day, dose 3
Feeling: Good · Site: Pain, Redness, Swelling · None

Adult check-in
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-24
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema peripheral, Pollakiuria — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches

MedDRA releases: 2024-11 · check-in answers available
2021-11-25
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema peripheral — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea

MedDRA releases: 2024-11 · check-in answers available
2021-11-26
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema peripheral — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Diarrhea

MedDRA releases: 2024-11 · check-in answers available
2021-11-27
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema peripheral — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Diarrhea

MedDRA releases: 2024-11 · check-in answers available
2021-11-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling, Itching · Diarrhea

Adult check-in
2021-11-29
Health check-in — 7 day, dose 3
Feeling: Good · Site: Swelling, Itching · Diarrhea

Adult check-in
2021-12-06
Health check-in — 14 day, dose 3
Feeling: Good

Adult check-in
2021-12-13
Health check-in — 21 day, dose 3
Feeling: Good

Adult check-in
2021-12-20
Health check-in — 28 day, dose 3
Feeling: Good

Adult check-in
2021-12-27
Health check-in — 35 day, dose 3
Feeling: Good

Adult check-in
2022-01-03
Survey response — 42 day, dose 3
MedDRA: Chills, Rhinorrhoea, Sneezing, Upper-airway cough syndrome — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-02-22
Survey response — 3 month, dose 3
MedDRA: Injection site pain, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11 · check-in answers available
2022-02-22
Report sent to call center — 3 month, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-24
Call 1 — Could Not Reach Participant
2022-03-01
Call 2 — Could Not Reach Participant
2022-05-25
Survey response — 6 month, dose 3
MedDRA: Injection site pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11 · check-in answers available
2022-05-25
Report sent to call center — 6 month, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-26
Call 1 — Left Voicemail
2022-05-26
Call 1 — Left Voicemail
2022-05-26
Call 3 — Left Voicemail
2022-05-26
Call 1 — Left Voicemail
2022-11-24
Survey response — 12 month, dose 3
MedDRA: Chills, Pyrexia — Feeling: Good

MedDRA releases: 2024-11 · check-in answers available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Moderna
2	2021-04-14	Moderna
3	2021-11-22	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-15	Unsuccessful
2021-10-13	Unsuccessful
2022-02-22	Unsuccessful
2022-05-25	Unsuccessful

Free text

Release 5

Systemic reaction (other): Warm feeling

Release 7

Symptoms: Fatigue

Systemic reaction (other): Fast heart rate 100 bpm

Systemic reaction (other): Fast heart rate

Release 8

Symptoms: Very drowsy

Symptoms: I have symptoms of a cold such as constant sneezing, runny nose and headache.

Release 9

Symptoms: Bursitis resulting in severe pain in the right shoulder during this week. Had an in-person Dr visit for additional treatment.

Healthcare visit (other): In-person Dr visit

Release 10

Symptoms: Bursitis and Shingles during separate periods of time

Systemic reaction (other): Frequent urination every 1/2 hour - swelling under the arm where I got the shot

Systemic reaction (other): Swelling under the arm the shot was given

Systemic reaction (other): Mild swelling under arm with shot

Systemic reaction (other): Swelling underarm is milder today

Symptoms: Runny nose Sneezing Post nasal drip Chills

Release 11

Symptoms: Continuous pain in the muscle I received the booster.

Healthcare visit (other): Pending in-person appointment with PCP

Symptoms: Still having pain in upper left arm where I received the booster in November 2021.

Release 12

Symptoms: Chills and fever.

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	Arthralgia	✓	·	✓
SD	Bursitis	✓	·	✓
SD	Chills	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Herpes zoster	·	·	✓
SD	Injection site pain	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Office visit	✓	·	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Sneezing	✓	✓	✓
SD	Somnolence	✓	✓	✓
SD	Upper-airway cough syndrome	·	·	✓
SRO	Feeling hot	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Oedema peripheral	·	·	✓
SRO	Pollakiuria	·	·	✓

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