Y89-18399-27433

3 vaccinations 8 coded responses 21 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 845 / UT
Registered: 2021-01-05

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

2021-01-05
Registered in v-safe
2021-01-05
Dose 1 — Moderna
2021-01-05
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness

Free text: no

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort, Arthralgia, Cough, Fatigue, Feeling cold, Malaise, Nausea, Pain, Sleep disorder — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Free text: abt 12 hrs after shot I probably had a low grade temp and felt cold..briefly felt mild nauseated with mild bowel upset and had a non-productive cough. All of these symptoms lasted a couple of hours. The malaise, joint and body aches are still with me and last night they hurt enough to keep me awake so I took a prescription pain pill and that worked. I am better today but still achy and little tired.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-11
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness

Free text: can't think of any other reason I feel so tired in middle of the day and nap hard for a couple of hours...?l

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-21
Survey response — day 14, dose 1
MedDRA: Injection site pruritus, Injection site rash, Injection site scab — Feeling: Good

Free text: The injection site got very itching and develop about a 5mm circular rash that eventually formed a thin scab lasting about a week. I still have the scab. Otherwise I am doing good.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-04
Dose 2 — Moderna
2021-02-04
Survey response — day 0, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to work

Free text: dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Influenza like illness — Feeling: Poor · Site: Pain, Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: lightheaded essay. flu like symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia — Feeling: Fair · Site: Pain, Swelling · Joint pains, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: weaknesses

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-11
Survey response — day 7, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: lumph glads under shot arm still sl swollen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-11-11
Dose 3 — Moderna
2022-02-04
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-02-10
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-05	Moderna
2	2021-02-04	Moderna
3	2021-11-11	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-06	priority 2/3

Free text

Release 1 — day 0, dose 1

2021-01-05

Systemic reaction (other): no

Release 1 — days 1–6 daily, dose 1

2021-01-06

Systemic reaction (other): abt 12 hrs after shot I probably had a low grade temp and felt cold..briefly felt mild nauseated with mild bowel upset and had a non-productive cough. All of these symptoms lasted a couple of hours. The malaise, joint and body aches are still with me and last night they hurt enough to keep me awake so I took a prescription pain pill and that worked. I am better today but still achy and little tired.

2021-01-11

Systemic reaction (other): can't think of any other reason I feel so tired in middle of the day and nap hard for a couple of hours...?l

Release 2 — day 14, dose 1

2021-01-21

Symptoms: The injection site got very itching and develop about a 5mm circular rash that eventually formed a thin scab lasting about a week. I still have the scab. Otherwise I am doing good.

Release 3 — day 0, dose 2

2021-02-04

Systemic reaction (other): dizziness

Release 3 — days 1–6 daily, dose 2

2021-02-05

Systemic reaction (other): lightheaded essay. flu like symptoms

2021-02-06

Systemic reaction (other): weaknesses

Release 4 — day 7, dose 2

2021-02-11

Systemic reaction (other): lumph glads under shot arm still sl swollen

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	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Injection site scab	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Anaphylaxis treatment	○	○	○
SRO	Arthralgia	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling cold	✓	✓	✓
SRO	Influenza like illness	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pyrexia	○	○	○
SRO	Sleep disorder	✓	✓	✓
SRO	Unevaluable event	○	○	○

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