Y56-98084-01819

3 vaccinations 9 coded responses 25 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 500 / IA
Registered: 2021-01-29

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

Registered dependents

BGV-71882-28307 Child or adolescent in my care · Male · 2022-02-28

A3K-36337-79567 Child or adolescent in my care · Male · 2022-07-22

Timeline

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

2020-12-29
Dose 1 — Moderna
2021-01-27
Dose 2 — Moderna
2021-01-29
Registered in v-safe
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth, Reaction to previous exposure to any vaccine — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Large raised and hard area around injection site. Approximately 2.5 inches by 3 inches and 0.5 inches in height. It was red, hot, and hard underneath. It itched a lot starting about 5 hours after injection and continued for about 12 hours. The other symptoms at the injection site remain the same now about 48 hours after. With the first vaccine, I had a small lump (size of marble) under my skin at the injection site that itched, but did not get red or hot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · None

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

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

Adult check-in
2021-02-03
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-17
Survey response — day 21, dose 2
MedDRA: Diarrhoea, Nausea — Feeling: Good

Free text: Diarrhea and nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — day 28, dose 2
MedDRA: Headache, Muscle fatigue — Feeling: Fair

Free text: Muscle fatigue and headache.

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

Adult check-in
2021-03-10
Survey response — day 42, dose 2
MedDRA: Diarrhoea — Feeling: Fair

Free text: Diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-28
Survey response — 6 months, dose 2
MedDRA: Nasal congestion, Oropharyngeal pain — Feeling: Fair · Be unable to work or attend school

Free text: Nasal congestion and sore throat.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-06
Dose 3 — Moderna
2021-11-08
Survey response — days 1–6 daily, dose 3
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-13
Survey response — day 7, dose 3
MedDRA: Nasal congestion — Feeling: Good

Free text: Stuffy nose

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-05
Survey response — day 28, dose 3
MedDRA: Eye discharge, Nasal congestion, Oropharyngeal pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sore throat, nasal congestion, eye drainage.

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-08
Call 2 — Left Voicemail
2021-12-12
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-20
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-06
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-09
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-06
Survey response — 12 months, dose 3
MedDRA: Oropharyngeal pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-07
Call 1 — Left Voicemail
2022-11-07
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-27	Moderna
3	2021-11-06	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-05	Unsuccessful
2022-11-06	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 2

2021-01-29

Systemic reaction (other): Large raised and hard area around injection site. Approximately 2.5 inches by 3 inches and 0.5 inches in height. It was red, hot, and hard underneath. It itched a lot starting about 5 hours after injection and continued for about 12 hours. The other symptoms at the injection site remain the same now about 48 hours after. With the first vaccine, I had a small lump (size of marble) under my skin at the injection site that itched, but did not get red or hot.

Release 4 — day 21, dose 2

2021-02-17

Symptoms: Diarrhea and nausea

Release 4 — day 28, dose 2

2021-02-24

Symptoms: Muscle fatigue and headache.

Release 5 — day 42, dose 2

2021-03-10

Symptoms: Diarrhea

Release 9 — 6 months, dose 2

2021-07-28

Symptoms: Nasal congestion and sore throat.

Release 10 — days 1–6 daily, dose 3

2021-11-08

Systemic reaction (other): Sore throat

Release 10 — day 7, dose 3

2021-11-13

Systemic reaction (other): Stuffy nose

Release 10 — day 28, dose 3

2021-12-05

Symptoms: Sore throat, nasal congestion, eye drainage.

Release 12 — 12 months, dose 3

2022-11-06

Symptoms: Sore throat

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	Diarrhoea	✓	✓	✓
SD	Eye discharge	·	·	✓
SD	Headache	✓	✓	✓
SD	Muscle fatigue	✓	✓	✓
SD	Nasal congestion	✓	·	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	✓	·	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site induration	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Injection site warmth	✓	✓	✓
SRO	Nasal congestion	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Reaction to previous exposure to any vaccine	✓	✓	✓

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