Y6R-74892-65752

2 vaccinations 12 coded responses 26 check-ins 12 free-text entries 6 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 921 / CA
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia — Feeling: Good · Site: Pain · Be unable to do your normal daily activities

Free text: Ive had some head tingling. Not sure if its related to vaccine or not. Started after I got my shot yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Anxiety, Paraesthesia, Stress — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Had some mild head tingling again not sure if it was related to vaccine or stress/anxiety

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-17
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia — Feeling: Good

Free text: Head tingling not sure if it is related to vaccine or not

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia — Feeling: Good

Free text: Occasionally head tingling. Again not sure if vaccine related or not

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Pain — Feeling: Good · Muscle or body aches

Free text: Dont think body aches are vaccine related

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-12
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Itching · Fever · Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work

Free text: Back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Itching · Headache, Fatigue or tiredness, Abdominal pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-02-15
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sharp back pain on side I got injection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Itching · Fatigue or tiredness

Free text: Back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia — Feeling: Fair · Muscle or body aches

Free text: Weakness on shot side of body. Maybe anxiety?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — day 7, dose 2
MedDRA: Discomfort — Feeling: Good · Fatigue or tiredness

Free text: Left sided discomfort (maybe anxiety)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-16
Call 1 — Left Voicemail
2021-03-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-13
Survey response — 6 months, dose 2
MedDRA: Abdominal pain upper, Nausea — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Nausea/bad stomach pain but it started 3 months after vaccine so I dont think its related?? Just happened to get bad nausea the past few months

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-13
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Call 1 — Left Voicemail
2022-02-12
Survey response — 12 months, dose 2
MedDRA: Postural orthostatic tachycardia syndrome, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, 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, Emergency room or emergency department visit

Free text: POTS, chronic urticaria

MedDRA releases: 2024-11 · check-in free text available
2022-02-12
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-02-15
Call 1 — Could Not Reach Participant
2022-02-18
Call 2 — Left Voicemail
2022-03-01
Call 3 — Left Voicemail
2022-03-07
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-12	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-15	Successful
2021-01-16	Successful
2021-02-15	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-02-16	Successful 2021-03-16	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-13	Successful	Participant prefers to complete VAERS report online
2022-02-12	Successful 2022-03-07	Participant prefers to complete VAERS report online

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Ive had some head tingling. Not sure if its related to vaccine or not. Started after I got my shot yesterday

2021-01-16

Systemic reaction (other): Had some mild head tingling again not sure if it was related to vaccine or stress/anxiety

2021-01-17

Systemic reaction (other): Head tingling not sure if it is related to vaccine or not

2021-01-18

Systemic reaction (other): Occasionally head tingling. Again not sure if vaccine related or not

2021-01-19

Systemic reaction (other): Dont think body aches are vaccine related

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Back pain

2021-02-16

Systemic reaction (other): Sharp back pain on side I got injection

2021-02-17

Systemic reaction (other): Back pain

2021-02-18

Systemic reaction (other): Weakness on shot side of body. Maybe anxiety?

Release 4 — day 7, dose 2

2021-02-19

Systemic reaction (other): Left sided discomfort (maybe anxiety)

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: Nausea/bad stomach pain but it started 3 months after vaccine so I dont think its related?? Just happened to get bad nausea the past few months

Release 11 — 12 months, dose 2

2022-02-12

Symptoms: POTS, chronic urticaria

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	Abdominal pain upper	✓	·	✓
SD	Nausea	✓	·	✓
SD	Postural orthostatic tachycardia syndrome	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Anxiety	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Discomfort	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Stress	✓	✓	✓

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