Y47-16670-16670

3 vaccinations 4 coded responses 32 check-ins 4 free-text entries 2 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 017 / MA
Registered: 2020-12-31

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

Registered dependents

FXN-30851-64604 Child or adolescent in my care · Female · 2021-12-05

Timeline

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

2020-12-31
Registered in v-safe
2020-12-31
Dose 1 — Moderna
2020-12-31
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Survey response — day 14, dose 1
MedDRA: Headache, Impaired work ability, Nasal congestion, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work

Free text: HA, mild ST, Mild stuffy nose, no fever. COVID neg. I answered unable to work as I need to a negative COVID test before I can see patients again.FYI: My 10yo sick 5 days after my symptoms started and she was Dx w/ Flu A on Tuesday , COVID NEG

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Report sent to call center — day 14, dose 1
Be unable to work

1 call case(s)
2021-01-21
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-28
Dose 2 — Moderna
2021-01-28
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Headache

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-04
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Survey response — day 14, dose 2
MedDRA: Office visit, Self-medication, Tendonitis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: I got a bad L shoulder post vaccine tendinitis (Dx by an Orthopedic MD) that did not allow me to do my ADLs. Started day 3 after shot, kept me awake at night day 5-11.Getting a bit better today with tons of ice and ibuprofen. · Healthcare visit (other): Ortho

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-04-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-19
Call 1 — Left Voicemail
2021-07-20
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-07-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-23
Dose 3 — Moderna
2021-12-05
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-14
Survey response — day 21, dose 3
MedDRA: Cough, Rhinorrhoea — Feeling: Fair

Free text: Runny nose and cough

MedDRA releases: 2024-11 · check-in free text available
2021-12-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-22
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-23
Survey response — 12 months, dose 3
MedDRA: Aphonia, COVID-19, Cough, Respiratory tract congestion, Upper respiratory tract infection — Feeling: Good · Be unable to work or attend school

Free text: COVID last week w uri, lost voice, mild cough and congestion

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Moderna
2	2021-01-28	Moderna
3	2021-11-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-14	priority 2/3
2021-02-11	Successful 2021-07-20	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — day 14, dose 1

2021-01-14

Symptoms: HA, mild ST, Mild stuffy nose, no fever. COVID neg. I answered unable to work as I need to a negative COVID test before I can see patients again.FYI: My 10yo sick 5 days after my symptoms started and she was Dx w/ Flu A on Tuesday , COVID NEG

Release 4 — day 14, dose 2

2021-02-11

Symptoms: I got a bad L shoulder post vaccine tendinitis (Dx by an Orthopedic MD) that did not allow me to do my ADLs. Started day 3 after shot, kept me awake at night day 5-11.Getting a bit better today with tons of ice and ibuprofen.

Healthcare visit (other): Ortho

Release 10 — day 21, dose 3

2021-12-14

Symptoms: Runny nose and cough

Release 12 — 12 months, dose 3

2022-11-23

Symptoms: COVID last week w uri, lost voice, mild cough and congestion

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	Aphonia	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Headache	✓	✓	✓
SD	Impaired work ability	✓	✓	✓
SD	Nasal congestion	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Tendonitis	✓	✓	✓
SD	Upper respiratory tract infection	·	·	✓

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