Y46-31610-42110

4 vaccinations 11 coded responses 47 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 920 / CA
Registered: 2021-02-06

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-06
Registered in v-safe
2021-02-06
Dose 1 — Moderna
2021-02-06
Health check-in — day 0, dose 1
Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Diarrhea

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Nausea — Feeling: Fair · Chills, Fatigue or tiredness, Nausea, Diarrhea

Free text: Last night after dinner wanted to throw up. Went to bed 7:30pm tired. Problem getting up this morning at 6:30am

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Gastrointestinal sounds abnormal — Feeling: Fair

Free text: Gurgling stomach

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-16
Dose 2 — Moderna
2021-03-16
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Fair · Headache

Free text: Woozy and dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · None

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Free text: Wozzy - Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Sore arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-15
Survey response — 6 months, dose 2
MedDRA: Muscle spasms — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Crampi g in groan area and otter thighs

MedDRA releases: 2024-11 · check-in free text available
2021-09-15
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-17
Call successful
Participant prefers to complete VAERS report online
2021-10-28
Dose 3 — Moderna
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue — Feeling: Fair · Site: Redness · Fatigue or tiredness

Free text: Tired

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness · Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-11
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-21
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-25
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-02
Survey response — day 35, dose 3
MedDRA: Nasal congestion, Productive cough, Respiratory tract congestion, Secretion discharge, Unevaluable event — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional

Free text: Symptoms: Have Bad Congestion nasal and chest. With coughing up mucus · Healthcare visit (other): Waiting for Tele appointment on Friday

MedDRA releases: 2024-11 · check-in free text available
2021-12-02
Report sent to call center — day 35, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-03
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-31
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-28
Survey response — 6 months, dose 3
MedDRA: Laboratory test abnormal — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Tested Positive with home test 4-24-2022

MedDRA releases: 2024-11 · check-in free text available
2022-04-28
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-04-29
Call 1 — Left Voicemail
2022-05-21
Dose 4 — Moderna
2022-05-21
Health check-in — day 0, dose 4
Feeling: Poor · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-23
Survey response — days 1–6 daily, dose 4
MedDRA: Limb discomfort, Self-medication — Feeling: Fair · Site: Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Day after booster couldn't touch left arm. Took 3 Advils to get relief

MedDRA releases: 2024-11 · check-in free text available
2022-05-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Redness · None

Adult check-in
2022-05-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Redness · Joint pains

Adult check-in
2022-05-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-31
Health check-in — day 7, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-06-04
Survey response — day 14, dose 4
MedDRA: Arthralgia — Feeling: Good

Free text: Last night my left shoulder was hurting in my sleep.

MedDRA releases: 2024-11 · check-in free text available
2022-06-13
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-18
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-25
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-04
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-11-19
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-21
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-06	Moderna
2	2021-03-16	Moderna
3	2021-10-28	Moderna	No
4	2022-05-21	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-15	Successful 2021-09-17	Participant prefers to complete VAERS report online
2021-12-02	Successful 2021-12-03	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-28	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-09

Systemic reaction (other): Last night after dinner wanted to throw up. Went to bed 7:30pm tired. Problem getting up this morning at 6:30am

Release 4 — days 1–6 daily, dose 1

2021-02-11

Systemic reaction (other): Gurgling stomach

Release 5 — day 0, dose 2

2021-03-16

Systemic reaction (other): Woozy and dizzy

Release 5 — days 1–6 daily, dose 2

2021-03-18

Systemic reaction (other): Wozzy - Dizziness

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): Sore arm

Release 9 — 6 months, dose 2

2021-09-15

Symptoms: Crampi g in groan area and otter thighs

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): Tired

Release 10 — day 35, dose 3

2021-12-02

Symptoms: Have Bad Congestion nasal and chest. With coughing up mucus

Healthcare visit (other): Waiting for Tele appointment on Friday

Release 11 — 6 months, dose 3

2022-04-28

Symptoms: Tested Positive with home test 4-24-2022

Release 11 — days 1–6 daily, dose 4

2022-05-23

Systemic reaction (other): Day after booster couldn't touch left arm. Took 3 Advils to get relief

Release 11 — day 14, dose 4

2022-06-04

Symptoms: Last night my left shoulder was hurting in my sleep.

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	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Productive cough	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Secretion discharge	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Gastrointestinal sounds abnormal	✓	✓	✓
SRO	Limb discomfort	·	·	✓
SRO	Nausea	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Self-medication	·	·	✓

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