XYV-23032-51245

3 vaccinations 8 coded responses 31 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 190 / PA
Registered: 2021-07-19

Relationship: Self
Race: Native Hawaiian or other Pacific Islander
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-07-01
Dose 1 — Moderna
2021-07-19
Registered in v-safe
2021-07-19
Survey response — 14 day, dose 1
MedDRA: Blister, Facial pain, Herpes zoster, Medical counselling, Office visit, Rash — 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

MedDRA releases: 2024-11 · check-in answers available
2021-07-19
Report sent to call center — 14 day, dose 1
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)
2021-07-22
Health check-in — 21 day, dose 1
Feeling: Fair

Adult check-in
2021-07-26
Call 1 — Left Voicemail
2021-07-29
Health check-in — 28 day, dose 1
Feeling: Good

Adult check-in
2021-07-30
Dose 2 — Moderna
2021-07-30
Health check-in — 0 day, dose 2
Feeling: Good · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-07-31
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-08-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-08-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Joint pains, Muscle or body aches

Adult check-in
2021-08-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Joint pains, Muscle or body aches

Adult check-in
2021-08-06
Health check-in — 7 day, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-08-13
Health check-in — 14 day, dose 2
Feeling: Good

Adult check-in
2021-08-20
Health check-in — 21 day, dose 2
Feeling: Fair

Adult check-in
2021-08-27
Health check-in — 28 day, dose 2
Feeling: Good

Adult check-in
2021-09-03
Health check-in — 35 day, dose 2
Feeling: Good

Adult check-in
2021-09-10
Health check-in — 42 day, dose 2
Feeling: Good

Adult check-in
2021-10-29
Health check-in — 3 month, dose 2
Feeling: Good

Adult check-in
2022-01-28
Survey response — 6 month, dose 2
MedDRA: Fatigue, Sneezing — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-02-04
Dose 3 — Moderna
2022-02-05
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activities

Adult check-in
2022-02-07
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal pain upper, Dizziness, Dry throat, Gastrointestinal disorder, Pre-existing disease, Throat irritation — Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-02-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2022-02-09
Survey response — days 1–6 daily, dose 3
MedDRA: Constipation, Gastrointestinal disorder — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

MedDRA releases: 2024-11 · check-in answers available
2022-02-13
Survey response — 7 day, dose 3
MedDRA: Constipation, Gastrointestinal disorder — Feeling: Good · Muscle or body aches, Fatigue or tiredness

MedDRA releases: 2024-11 · check-in answers available
2022-02-18
Health check-in — 14 day, dose 3
Feeling: Good

Adult check-in
2022-02-25
Health check-in — 21 day, dose 3
Feeling: Good

Adult check-in
2022-03-05
Health check-in — 28 day, dose 3
Feeling: Good

Adult check-in
2022-03-11
Health check-in — 35 day, dose 3
Feeling: Good

Adult check-in
2022-03-18
Health check-in — 42 day, dose 3
Feeling: Good

Adult check-in
2022-05-06
Survey response — 3 month, dose 3
MedDRA: Arthralgia, Musculoskeletal stiffness — Feeling: Good

MedDRA releases: 2024-11 · check-in answers available
2022-08-07
Survey response — 6 month, dose 3
MedDRA: Erythema, Peripheral swelling, Rash, Road traffic accident, Swelling, Swelling face — 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
2022-08-07
Report sent to call center — 6 month, 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 · Emergency room or emergency department visit · 1 call case(s)
2022-08-08
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-08
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-04
Survey response — 12 month, dose 3
MedDRA: Office visit, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11 · check-in answers available
2023-02-04
Report sent to call center — 12 month, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2023-02-06
Call 1 — Could Not Reach Participant
2023-02-06
Callback requested for
03:00PM

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-01	Moderna	No
2	2021-07-30	Moderna	No
3	2022-02-04	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-19	Successful 2022-08-08	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-07	Successful 2022-08-08	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-04	Unsuccessful

Free text

Release 9

Symptoms: Received 1st vaccine on 7/1. On 7/2 felt bumps on side of face turned into small blisters on 7/3 became more painful. Contacted my doctor and was diagnosed with Shingles and placed on Valacyclovir, Prednisone and Amoxicillan.

Healthcare visit (other): 7/7 office visit with my doctor

Release 11

Symptoms: Sneezing and being extremely tired for a 2-3 weeks.

Systemic reaction (other): Scratchy dry throat, stomach ache dizziness not sure if its truly vaccine or allergies and gi issues I have.

Systemic reaction (other): GI issues constipation

Systemic reaction (other): Had GI issues constipation- somewhat subsided.

Symptoms: Stiff muscles. Ache hips

Release 12

Symptoms: -Unexplained Facial cheek swelling and redness. Treated with Prednisone. -Unexpected rashes couple weeks later. Chest, arms, stomach, facial swelling, with spot brake outs; feels like mosquito bites.Unknown causes.

Healthcare visit (other): Unknown cause of facial swelling or of rash. Was also in auto accident.

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	Rash	·	·	✓
HCVO	Road traffic accident	·	·	✓
HCVO	Swelling face	·	·	✓
SD	Arthralgia	·	·	✓
SD	Blister	·	·	✓
SD	Erythema	·	·	✓
SD	Facial pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Herpes zoster	·	·	✓
SD	Medical counselling	·	·	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Rash	·	·	✓
SD	Sneezing	·	·	✓
SD	Swelling	·	·	✓
SD	Swelling face	·	·	✓
SRO	Abdominal pain upper	·	·	✓
SRO	Constipation	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dry throat	·	·	✓
SRO	Gastrointestinal disorder	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Throat irritation	·	·	✓

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