Y5E-51821-84640

1 vaccination 13 coded responses 16 check-ins 13 free-text entries 5 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 044 / ME
Registered: 2021-03-13

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

2021-03-13
Registered in v-safe
2021-03-13
Dose 1 — Moderna
2021-03-13
Survey response — day 0, dose 1
MedDRA: Chills, Dizziness, Immediate post-injection reaction, Nausea, Oropharyngeal pain, Palpitations, Paraesthesia — Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: About ten minutes after my shot, I started tingling head to toe, I had a few strong heart palpitations, dizziness and nausea. This afternoon chills and slight sore throat.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness, Nausea

Free text: Slight sore throat when I woke up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Nausea · Be unable to work

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: Poor · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work

Free text: Sore throat, stuffed up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain, Paraesthesia oral — Feeling: Fair · Chills, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work

Free text: Sore throat, and also something I havent listed but Ive had since I started having symptoms is that my tongue feels like I burned it on something hot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Fair · Chills, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Oropharyngeal pain — Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Sore throat, some chest pains

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-20
Survey response — day 7, dose 1
MedDRA: Oropharyngeal pain, Rash — Feeling: Fair · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Still having slight sore throat, still have rash

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — day 14, dose 1
MedDRA: Burning mouth syndrome, Chest pain, Chills, Emergency care, Hyperhidrosis, Nausea, Office visit, Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I had chest pains again and went to see my doctor. She said Ive had a systemic reaction and does not want me to get a second dose. Im still having chills/sweats, nausea, sore throat, burnt tongue feeling, although less frequent. · Healthcare visit (other): Regular, in-patient visit since I tested negative for covid at my ER visit.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Survey response — day 21, dose 1
MedDRA: Arthralgia — Feeling: Good

Free text: Joint pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-04-24
Survey response — day 42, dose 1
MedDRA: Intermenstrual bleeding — Feeling: Good

Free text: Not recently, but about 10 days after, I had spotting for the first time in 3+ years.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-12
Survey response — 3 months, dose 1
MedDRA: Chest pain, Emergency care, Sensation of foreign body — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I had to choose to ER again with chest pains and choking feeling in my throat.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-12
Report sent to call center — 3 months, dose 1
Be unable to work or attend school · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Call 1 — Left Voicemail
2021-09-13
Survey response — 6 months, dose 1
MedDRA: Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I have had a rash on my chest, neck and Face sin June 12. It has spread onto both sides of my face and neck. Three Drs cannot figure out what it is. I still have it. Right about the time my previous rash I developed 5 days after the vaccine · Healthcare visit (other): Dr office visit

MedDRA releases: 2024-11 · check-in free text available
2021-09-13
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-16
Call 1 — Could Not Reach Participant
2021-09-21
Call 2 — Could Not Reach Participant
2022-03-13
Survey response — 12 months, dose 1
MedDRA: Chest discomfort, Discomfort, Emergency care, Rash — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: I am still healing from a severe rash on my face and neck. I am still having chest /throat pressure off and on. · Healthcare visit (other): I have been to ER twice for chest pressure, numerous other doctors for the face/neck rash.

MedDRA releases: 2024-11 · check-in free text available
2022-03-13
Report sent to call center — 12 months, dose 1
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2022-03-15
Call 1 — Requested Callback
2022-03-16
Callback requested for
06:00PM ET
2022-03-16
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-13	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-19	Successful	Participant prefers to complete VAERS report online
2021-03-27	Successful	Participant prefers to complete VAERS report online
2021-06-12	Successful	Participant prefers to complete VAERS report online
2021-09-13	Successful	Participant prefers to complete VAERS report online
2022-03-13	Successful 2022-03-16	Participant prefers to complete VAERS report online

Free text

Release 5 — day 0, dose 1

2021-03-13

Systemic reaction (other): About ten minutes after my shot, I started tingling head to toe, I had a few strong heart palpitations, dizziness and nausea. This afternoon chills and slight sore throat.

Release 5 — days 1–6 daily, dose 1

2021-03-14

Systemic reaction (other): Slight sore throat when I woke up

2021-03-16

Systemic reaction (other): Sore throat, stuffed up

2021-03-17

Systemic reaction (other): Sore throat, and also something I havent listed but Ive had since I started having symptoms is that my tongue feels like I burned it on something hot.

2021-03-18

Systemic reaction (other): Sore throat

2021-03-19

Systemic reaction (other): Sore throat, some chest pains

Release 6 — day 7, dose 1

2021-03-20

Systemic reaction (other): Still having slight sore throat, still have rash

Release 6 — day 14, dose 1

2021-03-27

Symptoms: I had chest pains again and went to see my doctor. She said Ive had a systemic reaction and does not want me to get a second dose. Im still having chills/sweats, nausea, sore throat, burnt tongue feeling, although less frequent.

Healthcare visit (other): Regular, in-patient visit since I tested negative for covid at my ER visit.

Release 6 — day 21, dose 1

2021-04-03

Symptoms: Joint pain

Release 7 — day 42, dose 1

2021-04-24

Symptoms: Not recently, but about 10 days after, I had spotting for the first time in 3+ years.

Release 9 — 3 months, dose 1

2021-06-12

Symptoms: I had to choose to ER again with chest pains and choking feeling in my throat.

Release 9 — 6 months, dose 1

2021-09-13

Symptoms: I have had a rash on my chest, neck and Face sin June 12. It has spread onto both sides of my face and neck. Three Drs cannot figure out what it is. I still have it. Right about the time my previous rash I developed 5 days after the vaccine

Healthcare visit (other): Dr office visit

Release 11 — 12 months, dose 1

2022-03-13

Symptoms: I am still healing from a severe rash on my face and neck. I am still having chest /throat pressure off and on.

Healthcare visit (other): I have been to ER twice for chest pressure, numerous other doctors for the face/neck rash.

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	Chest discomfort	·	·	✓
HCVO	Emergency care	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Rash	·	·	✓
HCVO	SARS-CoV-2 test negative	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Burning mouth syndrome	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	Chest pain	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Discomfort	·	·	✓
SD	Emergency care	✓	✓	✓
SD	Hyperhidrosis	✓	✓	✓
SD	Intermenstrual bleeding	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Rash	·	·	✓
SD	Sensation of foreign body	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓

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