Y6H-21767-22241

3 vaccinations 5 coded responses 28 check-ins 5 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 760 / TX
Registered: 2021-01-11

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

2021-01-11
Registered in v-safe
2021-01-11
Dose 1 — Moderna
2021-01-11
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · Fatigue or tiredness

Adult check-in
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site erythema, Injection site mass, Injection site pruritus — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: I have developed an itchy red lump on the injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 7, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-01-25
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-01
Survey response — day 21, dose 1
MedDRA: Fatigue, Headache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headache that wont go away, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Dose 2 — Moderna
2021-02-08
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain, Itching · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Fatigue or tiredness, Diarrhea

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-15
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · 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
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Itching · None

Adult check-in
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Discomfort, Lymph node pain, Lymphadenopathy — Feeling: Good · Site: Pain, Redness, Swelling, Itching

Free text: Very swollen lymph node in my arm pit that is painful and uncomfortable

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Site: Redness, Itching

Free text: Painful swollen lymph node in armpit on side where I got the shot. The other side is normal.

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2022-01-27
Survey response — 3 months, dose 3
MedDRA: Colitis ulcerative, Pre-existing disease, SARS-CoV-2 test positive — 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, Emergency room or emergency department visit

Free text: I have ulcerative colitis and experienced a severe ulcerative colitis flare after testing positive for Covid-19. None of my medications for ulcerative colitis will bring the flare under control.

MedDRA releases: 2024-11 · check-in free text available
2022-01-27
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2022-02-01
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-11	Moderna
2	2021-02-08	Moderna
3	2021-10-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-27	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-13

Systemic reaction (other): I have developed an itchy red lump on the injection site

Release 3 — day 21, dose 1

2021-02-01

Symptoms: Headache that wont go away, fatigue

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): Very swollen lymph node in my arm pit that is painful and uncomfortable

2021-10-30

Systemic reaction (other): Painful swollen lymph node in armpit on side where I got the shot. The other side is normal.

Release 11 — 3 months, dose 3

2022-01-27

Symptoms: I have ulcerative colitis and experienced a severe ulcerative colitis flare after testing positive for Covid-19. None of my medications for ulcerative colitis will bring the flare under control.

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	Colitis ulcerative	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SRO	Discomfort	·	·	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site mass	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓

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