Y67-29917-08730

2 vaccinations 7 coded responses 16 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 307 / GA
Registered: 2021-04-16

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

2021-03-17
Dose 1 — Moderna
2021-04-16
Registered in v-safe
2021-04-16
Dose 2 — Moderna
2021-04-16
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-18
Survey response — days 1–6 daily, dose 2
MedDRA: Blood glucose increased — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Troube with blod sugar spiking

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — days 1–6 daily, dose 2
MedDRA: Blood glucose increased — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Blood sgars elaveted since injection on the 16th of april

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-21
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Poor · Site: Pain, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain a injection site,pain in muscle at injetion site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-23
Health check-in — day 7, dose 2
Feeling: Fair · Site: Itching · Fatigue or tiredness

Adult check-in
2021-04-30
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-07
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-14
Survey response — day 28, dose 2
MedDRA: Arthralgia, Lymph node pain, Pain in extremity — Feeling: Good

Free text: Arm and shoulder pain in left arm of last vaccination also sore lymph nodes in left arm pit , left side of left breast also neck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-28
Survey response — day 42, dose 2
MedDRA: Balance disorder, Dizziness, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Dizziness,balace issues · Healthcare visit (other): Primary care Dr

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-16
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-10-15
Survey response — 6 months, dose 2
MedDRA: Injection site pain, Muscle spasms, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Pain in right arm at 1st injection site. Muscle on arm has spasms · Healthcare visit (other): Dr visit primary care dr has referred me to an orthopedic dr

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-20
Call 1 — Left Voicemail
2022-04-16
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Hypoaesthesia, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Shoulder pain and numbness down to my hand · Healthcare visit (other): Dr. Visit

MedDRA releases: 2024-11 · check-in free text available
2022-04-16
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-21
Call 1 — Requested Callback
2022-04-22
Callback requested for
04:00PM ET
2022-04-22
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Moderna
2	2021-04-16	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-05-28	Successful	Does not wish to fill out VAERS report
2021-10-15	Successful	Does not wish to fill out VAERS report
2022-04-16	Successful 2022-04-22	Does not wish to fill out VAERS report

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-18

Systemic reaction (other): Troube with blod sugar spiking

2021-04-19

Systemic reaction (other): Blood sgars elaveted since injection on the 16th of april

2021-04-21

Systemic reaction (other): Pain a injection site,pain in muscle at injetion site

Release 8 — day 28, dose 2

2021-05-14

Symptoms: Arm and shoulder pain in left arm of last vaccination also sore lymph nodes in left arm pit , left side of left breast also neck

Release 8 — day 42, dose 2

2021-05-28

Symptoms: Dizziness,balace issues

Healthcare visit (other): Primary care Dr

Release 10 — 6 months, dose 2

2021-10-15

Symptoms: Pain in right arm at 1st injection site. Muscle on arm has spasms

Healthcare visit (other): Dr visit primary care dr has referred me to an orthopedic dr

Release 11 — 12 months, dose 2

2022-04-16

Symptoms: Shoulder pain and numbness down to my hand

Healthcare visit (other): Dr. Visit

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	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Balance disorder	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Hypoaesthesia	·	·	✓
SD	Injection site pain	·	·	✓
SD	Lymph node pain	✓	✓	✓
SD	Muscle spasms	·	·	✓
SD	Pain in extremity	✓	✓	✓
SRO	Blood glucose increased	✓	✓	✓
SRO	Injection site pain	✓	✓	✓

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