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XZY-33915-04976

4 vaccinations 27 coded responses 52 check-ins 27 free-text entries 2 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
481 / MI
Registered
2021-04-13
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-04-13
    Registered in v-safe
  2. 2021-04-13
    Dose 1 — Moderna
  3. 2021-04-13
    Health check-in — day 0, dose 1
    Feeling: Good · None
    Adult check-in
  4. 2021-04-14
    Survey response — days 1–6 daily, dose 1
    MedDRA: Arthritis, Pre-existing disease — Feeling: Good · Site: Pain
    Free text: Arthritis pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-04-16
    Survey response — days 1–6 daily, dose 1
    MedDRA: Arthralgia, Pain — Feeling: Good
    Free text: Arthritis aches and pain.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-04-17
    Survey response — days 1–6 daily, dose 1
    MedDRA: Arthralgia, Pre-existing disease — Feeling: Good
    Free text: Arthritis aches and pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-04-18
    Survey response — days 1–6 daily, dose 1
    MedDRA: Arthralgia — Feeling: Good
    Free text: Arthritis aches and pains.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-04-19
    Survey response — days 1–6 daily, dose 1
    MedDRA: Arthritis — Feeling: Good
    Free text: Arthritis
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-04-20
    Survey response — day 7, dose 1
    MedDRA: Pain, Pre-existing disease — Feeling: Good
    Free text: Arthritis aches and pain.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-04-28
    Survey response — day 14, dose 1
    MedDRA: Injection site erythema — Feeling: Good
    Free text: On Friday Apr. 21, I noticed arm red around area of injection. Arm ached slightly when went to bed. Took 2 extra strength Tylenol. Red almost gone on Apr. 25.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-05-04
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-05-11
    Dose 2 — Moderna
  13. 2021-05-12
    Survey response — days 1–6 daily, dose 2
    MedDRA: Myalgia, Pain, Pre-existing disease — Feeling: Fair · Site: Pain · Fatigue or tiredness
    Free text: Muscle or body aches probably mostly from arthritis.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-05-13
    Survey response — days 1–6 daily, dose 2
    MedDRA: Arthralgia — Feeling: Good · Site: Pain
    Free text: Arthritis aches and pain!
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-05-14
    Survey response — days 1–6 daily, dose 2
    MedDRA: Arthritis, Pain, Pre-existing disease — Feeling: Good · Site: Pain, Redness
    Free text: Arthritis aches and pains.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-05-15
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pain, Pre-existing disease — Feeling: Good · Site: Pain, Redness
    Free text: Arthritis aches and pains.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-05-16
    Survey response — days 1–6 daily, dose 2
    MedDRA: Injection site pruritus — Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site
    Free text: Aches and pain probably from arthritis? Itching lnot around injection site .
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-05-17
    Survey response — days 1–6 daily, dose 2
    MedDRA: Arthritis — Feeling: Good · Site: Itching
    Free text: Arthritis
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-05-18
    Survey response — day 7, dose 2
    MedDRA: Arthritis — Feeling: Good
    Free text: Arthritis
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  20. 2021-05-25
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-06-01
    Survey response — day 21, dose 2
    MedDRA: Pain in extremity, Self-medication — Feeling: Good
    Free text: When went to bed left arm ached in upper part of arm. Took 2 extra-strength Tylenol.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  22. 2021-06-08
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-06-15
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-06-22
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-08-12
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-11-09
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-11-12
    Dose 3 — Moderna
  28. 2021-11-13
    Survey response — days 1–6 daily, dose 3
    MedDRA: Arthritis, Feeling cold — Feeling: Fair · Site: Pain · Muscle or body aches
    Free text: I am cold but NOT chills. Some arthritis.
    MedDRA releases: 2024-11 · check-in free text available
  29. 2021-11-14
    Survey response — days 1–6 daily, dose 3
    MedDRA: Headache, Self-medication — Feeling: Good · Site: Pain
    Free text: Headache last night- took Tylenol
    MedDRA releases: 2024-11 · check-in free text available
  30. 2021-11-15
    Survey response — days 1–6 daily, dose 3
    MedDRA: Arthralgia — Feeling: Good
    Free text: Arthritis aches and pains.
    MedDRA releases: 2024-11 · check-in free text available
  31. 2021-11-16
    Survey response — days 1–6 daily, dose 3
    MedDRA: Arthralgia — Feeling: Good
    Free text: Just arthritis aches and pains.
    MedDRA releases: 2024-11 · check-in free text available
  32. 2021-11-17
    Survey response — days 1–6 daily, dose 3
    MedDRA: Arthralgia — Feeling: Good
    Free text: Arthritis aches and pains.
    MedDRA releases: 2024-11 · check-in free text available
  33. 2021-11-18
    Survey response — days 1–6 daily, dose 3
    MedDRA: Arthralgia — Feeling: Good
    Free text: Only, arthritis aches and pains.
    MedDRA releases: 2024-11 · check-in free text available
  34. 2021-11-19
    Survey response — day 7, dose 3
    MedDRA: Arthralgia — Feeling: Good
    Free text: Just arthritis aches and pains.
    MedDRA releases: 2024-11 · check-in free text available
  35. 2021-11-26
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  36. 2021-12-04
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  37. 2021-12-10
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  38. 2021-12-17
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  39. 2021-12-24
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  40. 2022-02-13
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  41. 2022-05-13
    Survey response — 6 months, dose 3
    MedDRA: Office visit, Oropharyngeal discolouration — Feeling: Good · Get care from a doctor or other healthcare professional
    Free text: Symptoms: White spots in throat like I had in Jan. When I had a sore throat ( omicron). · Healthcare visit (other): Office call
    MedDRA releases: 2024-11 · check-in free text available
  42. 2022-05-13
    Report sent to call center — 6 months, dose 3
    Get care from a doctor or other healthcare professional
    1 call case(s)
  43. 2022-05-16
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  44. 2022-05-19
    Dose 4 — Moderna
  45. 2022-05-19
    Health check-in — day 0, dose 4
    Feeling: Good · None
    Adult check-in
  46. 2022-05-21
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Site: Pain · None
    Adult check-in
  47. 2022-05-22
    Survey response — days 1–6 daily, dose 4
    MedDRA: Chest discomfort, Insomnia — Feeling: Good
    Free text: Drank tea with caffeine 7-8pm. Chest discomfort , couldn't sleep for awhile. Big mistake.
    MedDRA releases: 2024-11 · check-in free text available
  48. 2022-05-23
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  49. 2022-05-24
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  50. 2022-05-25
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  51. 2022-05-26
    Health check-in — day 7, dose 4
    Feeling: Good · None
    Adult check-in
  52. 2022-06-02
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  53. 2022-06-10
    Survey response — day 21, dose 4
    MedDRA: Asthma, Chest discomfort, Medical counselling, Office visit, Wheezing — Feeling: Good · Get care from a doctor or other healthcare professional
    Free text: Symptoms: Had wheezing (have intrinsic asthma) on Wednesday, June 8, and used inhaler twice that day. Chest felt slightly heavy. Used inhaler on Thursday am, went to Dr. and no wheezing. EKG normal. · Healthcare visit (other): Office call
    MedDRA releases: 2024-11 · check-in free text available
  54. 2022-06-10
    Report sent to call center — day 21, dose 4
    Get care from a doctor or other healthcare professional
    1 call case(s)
  55. 2022-06-13
  56. 2022-06-13
  57. 2022-06-13
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  58. 2022-06-16
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  59. 2022-06-25
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  60. 2022-07-02
    Survey response — day 42, dose 4
    MedDRA: Pre-existing disease, Rhinorrhoea — Feeling: Good
    Free text: Two days ago had runny nose but probably allergies. Pollen was up.
    MedDRA releases: 2024-11 · check-in free text available
  61. 2022-08-18
    Survey response — 3 months, dose 4
    MedDRA: Headache, Nasopharyngitis, Rhinorrhoea — Feeling: Good · Be unable to work or attend school
    Free text: 8-11-22 started with head cold symptoms (runny nose) in the evening. 8-12 still had runny nose and headache. 8-13 and 8-14 still had headaches. Since 8-15 feel OK.
    MedDRA releases: 2024-11 · check-in free text available
  62. 2022-11-17
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  63. 2023-05-19
    Health check-in — 12 months, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-04-13Moderna
22021-05-11Moderna
32021-11-12Moderna No
42022-05-19Moderna No

Call center

ReportedOutcomeVAERS-related outcome
2022-05-13 Successful
2022-05-16
 Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-10 Successful
2022-06-13
 Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-14

Systemic reaction (other): Arthritis pain

2021-04-16

Systemic reaction (other): Arthritis aches and pain.

2021-04-17

Systemic reaction (other): Arthritis aches and pain

2021-04-18

Systemic reaction (other): Arthritis aches and pains.

2021-04-19

Systemic reaction (other): Arthritis

Release 7 — day 7, dose 1

2021-04-20

Systemic reaction (other): Arthritis aches and pain.

Release 8 — day 14, dose 1

2021-04-28

Symptoms: On Friday Apr. 21, I noticed arm red around area of injection. Arm ached slightly when went to bed. Took 2 extra strength Tylenol. Red almost gone on Apr. 25.

Release 8 — days 1–6 daily, dose 2

2021-05-12

Systemic reaction (other): Muscle or body aches probably mostly from arthritis.

2021-05-13

Systemic reaction (other): Arthritis aches and pain!

2021-05-14

Systemic reaction (other): Arthritis aches and pains.

2021-05-15

Systemic reaction (other): Arthritis aches and pains.

2021-05-16

Systemic reaction (other): Aches and pain probably from arthritis? Itching lnot around injection site .

2021-05-17

Systemic reaction (other): Arthritis

Release 8 — day 7, dose 2

2021-05-18

Systemic reaction (other): Arthritis

Release 8 — day 21, dose 2

2021-06-01

Symptoms: When went to bed left arm ached in upper part of arm. Took 2 extra-strength Tylenol.

Release 10 — days 1–6 daily, dose 3

2021-11-13

Systemic reaction (other): I am cold but NOT chills. Some arthritis.

2021-11-14

Systemic reaction (other): Headache last night- took Tylenol

2021-11-15

Systemic reaction (other): Arthritis aches and pains.

2021-11-16

Systemic reaction (other): Just arthritis aches and pains.

2021-11-17

Systemic reaction (other): Arthritis aches and pains.

2021-11-18

Systemic reaction (other): Only, arthritis aches and pains.

Release 10 — day 7, dose 3

2021-11-19

Systemic reaction (other): Just arthritis aches and pains.

Release 11 — 6 months, dose 3

2022-05-13

Symptoms: White spots in throat like I had in Jan. When I had a sore throat ( omicron).
Healthcare visit (other): Office call

Release 11 — days 1–6 daily, dose 4

2022-05-22

Systemic reaction (other): Drank tea with caffeine 7-8pm. Chest discomfort , couldn't sleep for awhile. Big mistake.

Release 12 — day 21, dose 4

2022-06-10

Symptoms: Had wheezing (have intrinsic asthma) on Wednesday, June 8, and used inhaler twice that day. Chest felt slightly heavy. Used inhaler on Thursday am, went to Dr. and no wheezing. EKG normal.
Healthcare visit (other): Office call

Release 12 — day 42, dose 4

2022-07-02

Symptoms: Two days ago had runny nose but probably allergies. Pollen was up.

Release 12 — 3 months, dose 4

2022-08-18

Symptoms: 8-11-22 started with head cold symptoms (runny nose) in the evening. 8-12 still had runny nose and headache. 8-13 and 8-14 still had headaches. Since 8-15 feel OK.

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

FieldPreferred term2021-092023-042024-11
HCVOMedical counselling · · ✓
HCVOOffice visit · · ✓
SDAsthma · · ✓
SDChest discomfort · · ✓
SDHeadache · · ✓
SDInjection site erythema ✓ ✓ ✓
SDNasopharyngitis · · ✓
SDOffice visit · · ✓
SDOropharyngeal discolouration · · ✓
SDPain in extremity ✓ ✓ ✓
SDPre-existing disease · · ✓
SDRhinorrhoea · · ✓
SDSelf-medication ✓ ✓ ✓
SDWheezing · · ✓
SROArthralgia ✓ ✓ ✓
SROArthritis ✓ ✓ ✓
SROChest discomfort · · ✓
SROFeeling cold · · ✓
SROHeadache · · ✓
SROInjection site pruritus ✓ ✓ ✓
SROInsomnia · · ✓
SROMyalgia ✓ ✓ ✓
SROPain ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓
SROSelf-medication · · ✓

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

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