Y86-31440-73977
5 vaccinations
4 coded responses
56 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 225 / VA
- Registered
- 2021-03-07
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-05
Dose 1 — Moderna
-
2021-03-07
Registered in v-safe
-
2021-03-07
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-03-08
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-13
-
2021-03-20
Survey response — day 14, dose 1MedDRA: Arthralgia, Injection site pain, Mobility decreased — Feeling: Good · Be unable to do your normal daily activitiesFree text: Left shoulder pain intermittent, sometimes unable to raise my arm (injection arm). Ibuprofen helps. I believe the injection was placed too far up, only an inch down from acromion process on my slender arm. Same pain as post injectionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-27
Survey response — day 21, dose 1MedDRA: Crying, Depressed mood, Fatigue, Headache — Feeling: FairFree text: Generally fatigued with episodes of deep sadness unrelated to anything going on in my life. This sadness happened the night after vaccine, and I cried for 1/2 hour. I didnt mention it then because I wasnt sure if vacc related but has recurredMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-02
Dose 2 — Moderna
- 2021-04-02
-
2021-04-03
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Swelling · Fever · Chills, Fatigue or tirednessAdult check-in
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-08
- 2021-04-11
- 2021-04-16
- 2021-04-24
- 2021-05-02
- 2021-05-09
- 2021-05-14
- 2021-07-02
- 2021-10-02
-
2021-12-03
Dose 3 — Moderna
- 2021-12-05
- 2021-12-07
- 2021-12-08
- 2021-12-09
- 2021-12-10
- 2021-12-17
- 2021-12-24
- 2021-12-31
- 2022-01-07
- 2022-01-14
-
2022-03-04
Survey response — 3 months, dose 3MedDRA: Hypertension — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: HypertensionMedDRA releases: 2024-11 · check-in free text available
-
2022-03-04
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
-
2022-03-07
Call successfulParticipant prefers to complete VAERS report online
- 2022-06-03
-
2022-07-28
Dose 4 — Moderna
- 2022-07-28
- 2022-07-29
- 2022-07-30
- 2022-07-31
- 2022-08-01
- 2022-08-02
- 2022-08-03
- 2022-08-04
- 2022-08-11
- 2022-08-26
- 2022-09-02
- 2022-09-11
- 2022-10-27
-
2022-11-04
Dose 5 — Moderna
- 2022-11-06
- 2022-11-07
- 2022-11-08
- 2022-11-09
- 2022-11-10
- 2022-11-11
- 2022-11-21
- 2022-11-27
-
2022-12-12
Survey response — day 35, dose 5MedDRA: Diarrhoea, Nausea, Vomiting — Feeling: Good · Be unable to do your normal daily activitiesFree text: Nausea vomiting diarrhea for 4 daysMedDRA releases: 2024-11 · check-in free text available
- 2023-02-05
- 2023-05-07
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-05 | Moderna | |
| 2 | 2021-04-02 | Moderna | |
| 3 | 2021-12-03 | Moderna | No |
| 4 | 2022-07-28 | Moderna | No |
| 5 | 2022-11-04 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-03-04 | Successful 2022-03-07 |
Participant prefers to complete VAERS report online |
Free text
Release 6 — day 14, dose 1
Symptoms: Left shoulder pain intermittent, sometimes unable to raise my arm (injection arm). Ibuprofen helps. I believe the injection was placed too far up, only an inch down from acromion process on my slender arm. Same pain as post injection
Release 6 — day 21, dose 1
Symptoms: Generally fatigued with episodes of deep sadness unrelated to anything going on in my life. This sadness happened the night after vaccine, and I cried for 1/2 hour. I didnt mention it then because I wasnt sure if vacc related but has recurred
Release 11 — 3 months, dose 3
Symptoms: Hypertension
Release 12 — day 35, dose 5
Symptoms: Nausea vomiting diarrhea for 4 days
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 | Arthralgia | ✓ | ✓ | ✓ |
| SD | Crying | ✓ | ✓ | ✓ |
| SD | Depressed mood | ✓ | ✓ | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Hypertension | · | · | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Mobility decreased | ✓ | ✓ | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release