Y4L-11075-18795

5 vaccinations 20 coded responses 46 check-ins 18 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 920 / CA
Registered: 2021-01-16

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

Timeline

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

2021-01-16
Registered in v-safe
2021-01-16
Dose 1 — Moderna
2021-01-16
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good · Site: Pain

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Pain where shot was given still.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: Still pain in the arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: Pain in arm is a little better

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: Pain in the whole arm that shot was given

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Survey response — day 7, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Be unable to do your normal daily activities

Free text: Arm is a little less painful.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Survey response — day 14, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Arm still hurts after two weeks.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — day 21, dose 1
MedDRA: Insomnia, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Arm hurts still. Not able to sleep as well.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — day 28, dose 1
MedDRA: Arthralgia, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Shoulder and upper arm still hurts. Wakes me up at night. Calling dr tomorrow.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-20
Survey response — day 35, dose 1
MedDRA: Arthralgia, Pain in extremity — Feeling: Good · Be unable to do your normal daily activities

Free text: Arm still hurts mainly in shoulder area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Dose 2 — Moderna
2021-02-23
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Fair · Site: Pain, Swelling

Free text: Fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · None

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: Arm a little more sore last night.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-23
Survey response — day 28, dose 2
MedDRA: Sleep disorder, Vaccination site pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: My vaccination arm still hurts off and on. Wakes me up at night sometimes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-31
Call 1 — Left Voicemail
2021-08-24
Survey response — 6 months, dose 2
MedDRA: Asthenia, Chills, Headache, Lethargy, Pain in extremity, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: 3rd Vaccine given about a week ago. Fever chills headache lethargy weakness for about 24 hours. Couple days of decreased energy. Good now. Arm sore about 24 hours

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-25
Dose 3 — Moderna
2021-11-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-23
Survey response — 6 months, dose 3
MedDRA: Malaise, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities

Free text: Sick for couple days negative home test but felt like mild covid

MedDRA releases: 2024-11 · check-in free text available
2022-03-09
Dose 4 — Moderna
2022-04-14
Survey response — day 35, dose 4
MedDRA: Chills, Malaise, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: Side effects from booster. Chills fever malaise sore sm

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Health check-in — day 42, dose 4
Feeling: Good

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

Adult check-in
2022-09-09
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-10-11
Dose 5 — Pfizer-BioNTech
Co-administered: Flu
2022-10-12
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-10-13
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Itching · Nausea

Adult check-in
2022-10-14
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection site

Adult check-in
2022-10-15
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-16
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-17
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-18
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-25
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-01
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-08
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-16
Survey response — day 35, dose 5
MedDRA: Headache — Feeling: Good

Free text: Headaches

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Survey response — day 42, dose 5
MedDRA: Headache — Feeling: Good

Free text: Headaches once in awhile.

MedDRA releases: 2024-11 · check-in free text available
2023-01-10
Survey response — 3 months, dose 5
MedDRA: Arthralgia — Feeling: Good

MedDRA releases: 2024-11
2023-04-13
Survey response — 6 months, dose 5
MedDRA: COVID-19, Fatigue, Pain, Parosmia, Rhinorrhoea, Sneezing — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-16	Moderna
2	2021-02-23	Moderna
3	2021-08-25	Moderna	No
4	2022-03-09	Moderna	No
5	2022-10-11	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-02-13	Unsuccessful

Free text

Release 2 — day 0, dose 1

2021-01-16

Systemic reaction (other): No

Release 2 — days 1–6 daily, dose 1

2021-01-17

Systemic reaction (other): Pain where shot was given still.

2021-01-19

Systemic reaction (other): Still pain in the arm.

2021-01-21

Systemic reaction (other): Pain in arm is a little better

2021-01-22

Systemic reaction (other): Pain in the whole arm that shot was given

Release 2 — day 7, dose 1

2021-01-23

Systemic reaction (other): Arm is a little less painful.

Release 3 — day 14, dose 1

2021-01-30

Symptoms: Arm still hurts after two weeks.

Release 3 — day 21, dose 1

2021-02-07

Symptoms: Arm hurts still. Not able to sleep as well.

Release 4 — day 28, dose 1

2021-02-13

Symptoms: Shoulder and upper arm still hurts. Wakes me up at night. Calling dr tomorrow.

Release 4 — day 35, dose 1

2021-02-20

Symptoms: Arm still hurts mainly in shoulder area.

Release 4 — days 1–6 daily, dose 2

2021-02-25

Systemic reaction (other): Fatigue

2021-03-01

Systemic reaction (other): Arm a little more sore last night.

Release 6 — day 28, dose 2

2021-03-23

Symptoms: My vaccination arm still hurts off and on. Wakes me up at night sometimes.

Release 9 — 6 months, dose 2

2021-08-24

Symptoms: 3rd Vaccine given about a week ago. Fever chills headache lethargy weakness for about 24 hours. Couple days of decreased energy. Good now. Arm sore about 24 hours

Release 11 — 6 months, dose 3

2022-02-23

Symptoms: Sick for couple days negative home test but felt like mild covid

Release 11 — day 35, dose 4

2022-04-14

Symptoms: Side effects from booster. Chills fever malaise sore sm

Release 12 — day 35, dose 5

2022-11-16

Symptoms: Headaches

Release 12 — day 42, dose 5

2022-11-22

Symptoms: Headaches once in awhile.

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	Arthralgia	✓	✓	✓
SD	Asthenia	✓	·	✓
SD	Chills	✓	·	✓
SD	COVID-19	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	·	✓
SD	Insomnia	✓	✓	✓
SD	Lethargy	✓	·	✓
SD	Malaise	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Parosmia	·	·	✓
SD	Pyrexia	✓	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sleep disorder	✓	✓	✓
SD	Sneezing	·	·	✓
SD	Vaccination site pain	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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