Y4E-25146-72300

4 vaccinations 9 coded responses 33 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 193 / PA
Registered: 2021-03-28

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

2021-03-26
Dose 1 — Moderna
2021-03-28
Registered in v-safe
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-29
Survey response — days 1–6 daily, dose 1
MedDRA: Periorbital swelling, Pruritus — Feeling: Good · Fatigue or tiredness

Free text: Slightly swollen under left eye, was itching has stopped.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-01
Survey response — days 1–6 daily, dose 1
MedDRA: Deformity, Joint swelling, Oedema peripheral, Periorbital swelling, Swelling of eyelid — Feeling: Good · Site: Swelling

Free text: Swelling around arms along both elbows, also under both eyes. No pain or itching, just looks puffy/slightly deformed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-23
Dose 2 — Moderna
2021-04-23
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-27
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain — Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea

Free text: Chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-30
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-28
Survey response — day 35, dose 2
MedDRA: Contusion, Peripheral swelling, Rash — Feeling: Good

Free text: Bruising on left arm and slight rash/swelling of upper arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-23
Survey response — 3 months, dose 2
MedDRA: Bronchitis, Cough, Exposure to contaminated air, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I contracted bronchitis from exposure to construction materials: dust and mold. Due to the cough I immediately went for Covid 19 testing: I was negative.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-23
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-29
Call 2 — Left Voicemail
2021-10-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-21
Dose 3 — Moderna
2022-04-23
Survey response — 12 months, dose 2
MedDRA: Back pain, Endometriosis, Injury, Menopausal symptoms, Nerve injury, Rectal haemorrhage, Road traffic accident — Feeling: Good · Be unable to do your normal daily activities

Free text: Do not feel they are related to inoculation or Covid. Back Pain and nerve damage result of car accident injury. Menopausal symptoms and endometriosis/rectal bleed.

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Dose 4 — Moderna
2022-05-16
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-21
Survey response — day 14, dose 4
MedDRA: Blood pressure increased, Pre-existing disease — Feeling: Good

Free text: My blood pressure seems to be higher but it was running high prior to my vaccination

MedDRA releases: 2024-11 · check-in free text available
2022-05-28
Survey response — day 21, dose 4
MedDRA: Influenza, Nasopharyngitis, Night sweats, Rhinorrhoea, Sneezing — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I have a cold/flu that is not COVID-19: sniffles, sneezes, night sweats

MedDRA releases: 2024-11 · check-in free text available
2022-05-28
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-06-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-11
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-20
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-06
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-05
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-07
Survey response — 12 months, dose 4
MedDRA: Diarrhoea, Fatigue, Hot flush, Irritability, Menopause, Rectal haemorrhage, Vaginal discharge — Feeling: Good

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-26	Moderna
2	2021-04-23	Moderna
3	2021-11-21	Moderna	No
4	2022-05-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-07-23	Unsuccessful
2022-05-28	Unsuccessful

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-29

Systemic reaction (other): Slightly swollen under left eye, was itching has stopped.

2021-04-01

Systemic reaction (other): Swelling around arms along both elbows, also under both eyes. No pain or itching, just looks puffy/slightly deformed.

Release 8 — days 1–6 daily, dose 2

2021-04-27

Systemic reaction (other): Chest pain

Release 8 — day 35, dose 2

2021-05-28

Symptoms: Bruising on left arm and slight rash/swelling of upper arm

Release 9 — 3 months, dose 2

2021-07-23

Symptoms: I contracted bronchitis from exposure to construction materials: dust and mold. Due to the cough I immediately went for Covid 19 testing: I was negative.

Release 11 — 12 months, dose 2

2022-04-23

Symptoms: Do not feel they are related to inoculation or Covid. Back Pain and nerve damage result of car accident injury. Menopausal symptoms and endometriosis/rectal bleed.

Release 11 — day 14, dose 4

2022-05-21

Symptoms: My blood pressure seems to be higher but it was running high prior to my vaccination

Release 11 — day 21, dose 4

2022-05-28

Symptoms: I have a cold/flu that is not COVID-19: sniffles, sneezes, night sweats

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
SD	Back pain	·	·	✓
SD	Blood pressure increased	·	·	✓
SD	Bronchitis	✓	·	✓
SD	Contusion	✓	✓	✓
SD	Cough	✓	·	✓
SD	Diarrhoea	·	·	✓
SD	Endometriosis	·	·	✓
SD	Exposure to contaminated air	✓	·	✓
SD	Fatigue	·	·	✓
SD	Hot flush	·	·	✓
SD	Influenza	·	·	✓
SD	Injury	·	·	✓
SD	Irritability	·	·	✓
SD	Menopausal symptoms	·	·	✓
SD	Menopause	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nerve injury	·	·	✓
SD	Night sweats	·	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Rash	✓	✓	✓
SD	Rectal haemorrhage	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Road traffic accident	·	·	✓
SD	SARS-CoV-2 test negative	✓	·	✓
SD	Sneezing	·	·	✓
SD	Vaginal discharge	·	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Deformity	✓	✓	✓
SRO	Eye swelling	○	○	○
SRO	Joint swelling	✓	✓	✓
SRO	Oedema peripheral	✓	✓	✓
SRO	Periorbital swelling	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Swelling of eyelid	✓	✓	✓

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