Y4P-29823-56204

2 vaccinations 13 coded responses 23 check-ins 13 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 077 / NJ
Registered: 2021-01-29

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

2021-01-28
Dose 1 — Moderna
2021-01-29
Registered in v-safe
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-02-02
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Good · Nausea

Free text: Loss of appetite for the last 3 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Good · Headache, Nausea

Free text: Lost appetite for 3 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-02-11
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-18
Survey response — day 21, dose 1
MedDRA: Rash — Feeling: Good

Free text: Mild rash on stomach

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Dose 2 — Moderna
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · 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
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in jaw — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Jaw pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in jaw — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Jaw pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-03-04
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-11
Survey response — day 14, dose 2
MedDRA: Arthralgia, Myalgia, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Chronic Joint & muscle pain throughout entire body.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — day 21, dose 2
MedDRA: Arthralgia, Headache, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Continued Joint & muscle pain & headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — day 28, dose 2
MedDRA: Abdominal discomfort, Arthralgia, Muscle spasms — Feeling: Fair · Be unable to do your normal daily activities

Free text: Continued chronic joint pain & muscle spasms, & stomach upset.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 35, dose 2
MedDRA: Abdominal discomfort, Arthralgia, Gait disturbance, Headache, Mobility decreased, Myalgia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Chronic muscles & joint pain in legs, hips, knees, feet causing difficulty walking, sitting & climbing stairs; Headaches; stomach issues.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — day 42, dose 2
MedDRA: Arthralgia, Back pain, Condition aggravated, Dysstasia, Gait disturbance, Headache, Loss of personal independence in daily activities, Musculoskeletal pain, Pain in extremity, Pre-existing disease, Sciatica, Sitting disability, Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Chronic pain in both legs, knees, feet, lower back, butt, sciatica, both arms, & headaches. Difficulty climbing stairs, driving, sitting, standing, & walking. I have Fibromyalgia & Dr. thinks the vaccine caused a flare up. · Healthcare visit (other): MRI & Bloodwork & pain medication.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-27
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Mobility decreased, Muscle spasms, Myalgia, Pain, Physiotherapy — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Addtl joint & muscle pain: legs, feet, knees & low back, right arm deltoid muscle & AC joint very painful; dont have full use of arm. The pain throughout my body keeps shifting to multiple areas. Both legs cramping severely daily. Head · Healthcare visit (other): Physical Therapy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-27
Report sent to call center — 3 months, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-26
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Mobility decreased, Office visit, Pre-existing disease — Feeling: Poor · 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: Symptoms: Continued chronic back, legs, knees, muscle & joint pain. Additional Severe Shoulder pain. Could not use my arm. · Healthcare visit (other): In person doctor visit & MRI

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-26
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-30
Call successful
Participant prefers to complete VAERS report online
2022-02-26
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Fall, Limb mass, Muscular weakness, Pain, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: Upper body, both arms/shoulder severe pains radiating sharp pains down arms through hands. Left arm worse. Lump on right upper arm since vaccine still there. Top of Left leg near torso is weak, periodically collapsing.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-28	Moderna
2	2021-02-25	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-08	Successful	Participant prefers to complete VAERS report online
2021-05-27	Successful	Participant prefers to complete VAERS report online
2021-08-26	Successful 2021-08-30	Participant prefers to complete VAERS report online

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-02

Systemic reaction (other): Loss of appetite for the last 3 days.

2021-02-03

Systemic reaction (other): Lost appetite for 3 days

Release 4 — day 21, dose 1

2021-02-18

Symptoms: Mild rash on stomach

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): Jaw pain

2021-03-02

Systemic reaction (other): Jaw pain

Release 5 — day 14, dose 2

2021-03-11

Symptoms: Chronic Joint & muscle pain throughout entire body.

Release 5 — day 21, dose 2

2021-03-18

Symptoms: Continued Joint & muscle pain & headaches

Release 6 — day 28, dose 2

2021-03-25

Symptoms: Continued chronic joint pain & muscle spasms, & stomach upset.

Release 6 — day 35, dose 2

2021-04-01

Symptoms: Chronic muscles & joint pain in legs, hips, knees, feet causing difficulty walking, sitting & climbing stairs; Headaches; stomach issues.

Release 7 — day 42, dose 2

2021-04-08

Symptoms: Chronic pain in both legs, knees, feet, lower back, butt, sciatica, both arms, & headaches. Difficulty climbing stairs, driving, sitting, standing, & walking. I have Fibromyalgia & Dr. thinks the vaccine caused a flare up.

Healthcare visit (other): MRI & Bloodwork & pain medication.

Release 8 — 3 months, dose 2

2021-05-27

Symptoms: Addtl joint & muscle pain: legs, feet, knees & low back, right arm deltoid muscle & AC joint very painful; dont have full use of arm. The pain throughout my body keeps shifting to multiple areas. Both legs cramping severely daily. Head

Healthcare visit (other): Physical Therapy

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: Continued chronic back, legs, knees, muscle & joint pain. Additional Severe Shoulder pain. Could not use my arm.

Healthcare visit (other): In person doctor visit & MRI

Release 11 — 12 months, dose 2

2022-02-26

Symptoms: Upper body, both arms/shoulder severe pains radiating sharp pains down arms through hands. Left arm worse. Lump on right upper arm since vaccine still there. Top of Left leg near torso is weak, periodically collapsing.

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	✓	·	✓
HCVO	Physiotherapy	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Abdominal discomfort	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Dysstasia	✓	✓	✓
SD	Fall	·	·	✓
SD	Gait disturbance	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Limb mass	·	·	✓
SD	Loss of personal independence in daily activities	✓	✓	✓
SD	Mobility decreased	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Muscular weakness	·	·	✓
SD	Musculoskeletal pain	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Sciatica	✓	✓	✓
SD	Sitting disability	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Pain in jaw	✓	✓	✓

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