Y46-23019-76435

2 vaccinations 7 coded responses 23 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 610 / IL
Registered: 2021-02-23

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-02-22
Dose 1 — Moderna
2021-02-23
Registered in v-safe
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Headache

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Muscle or body aches, Nausea

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Itching · Headache

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness · Headache

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-01
Survey response — day 7, dose 1
MedDRA: Pain in extremity, Swelling — Feeling: Fair · Site: Pain, Redness, Itching · Headache

Free text: A lot of pain in my leg thought I might have a blood clot. Elevation made the swelling go down.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-22
Dose 2 — Moderna
2021-03-22
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches

Adult check-in
2021-03-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Diarrhea

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-03-29
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-04-05
Survey response — day 14, dose 2
MedDRA: Fatigue, Headache, Sensation of foreign body — Feeling: Fair

Free text: Headaches like a vice grip and tired a lot and feels like I have I have something caught in my throat.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — day 21, dose 2
MedDRA: Burning sensation, Headache, Sensation of foreign body — Feeling: Fair · Be unable to do your normal daily activities

Free text: Burning in both legs and feeling of a lump in my throat. Still having headaches from time to time.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — day 28, dose 2
MedDRA: Cough, Sensation of foreign body — Feeling: Fair

Free text: Persistent coughing.and feeling of throat having a lump

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — day 35, dose 2
MedDRA: Chills, Headache, Pain in jaw — Feeling: Poor · Be unable to do your normal daily activities

Free text: Really really bad chills and major pain going up both sides of my jaw. Bad headache with head feeling like its in a Vice.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — day 42, dose 2
MedDRA: Dyspnoea, Headache, Oedema peripheral — Feeling: Fair

Free text: Headache continues and difficult breathing if I excuse. Swelling in both my legs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-22
Survey response — 3 months, dose 2
MedDRA: Blood test abnormal, Office visit, Peripheral swelling, SARS-CoV-2 test negative, Thrombosis — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Blood work showed elevated of blood clot. Wearing heart monitor, echo done and CY scan of cheats. Legs swollen getting vein study gone. Tested for covid was negative · Healthcare visit (other): Office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-22
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-28
Call 1 — Left Voicemail
2021-07-01
Call successful
Does not wish to fill out VAERS report
2021-09-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-22	Moderna
2	2021-03-22	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-22	Successful 2021-07-01	Does not wish to fill out VAERS report

Free text

Release 4 — day 7, dose 1

2021-03-01

Systemic reaction (other): A lot of pain in my leg thought I might have a blood clot. Elevation made the swelling go down.

Release 6 — day 14, dose 2

2021-04-05

Symptoms: Headaches like a vice grip and tired a lot and feels like I have I have something caught in my throat.

Release 7 — day 21, dose 2

2021-04-13

Symptoms: Burning in both legs and feeling of a lump in my throat. Still having headaches from time to time.

Release 7 — day 28, dose 2

2021-04-19

Symptoms: Persistent coughing.and feeling of throat having a lump

Release 8 — day 35, dose 2

2021-04-26

Symptoms: Really really bad chills and major pain going up both sides of my jaw. Bad headache with head feeling like its in a Vice.

Release 8 — day 42, dose 2

2021-05-03

Symptoms: Headache continues and difficult breathing if I excuse. Swelling in both my legs

Release 9 — 3 months, dose 2

2021-06-22

Symptoms: Blood work showed elevated of blood clot. Wearing heart monitor, echo done and CY scan of cheats. Legs swollen getting vein study gone. Tested for covid was negative

Healthcare visit (other): Office

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
HCVO	Office visit	✓	✓	✓
SD	Blood test abnormal	✓	✓	✓
SD	Burning sensation	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Oedema peripheral	✓	✓	✓
SD	Pain in jaw	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sensation of foreign body	✓	✓	✓
SD	Thrombosis	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Swelling	✓	✓	✓

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