Y8U-19199-68715

4 vaccinations 12 coded responses 52 check-ins 12 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 921 / CA
Registered: 2021-01-27

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

2021-01-27
Registered in v-safe
2021-01-27
Dose 1 — Moderna
2021-01-27
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased activity — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Free text: Am retired so able to decrease activity.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-04
Health check-in — day 7, dose 1
Feeling: Fair · Site: Redness, Swelling, Itching · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-10
Survey response — day 14, dose 1
MedDRA: Fatigue, Peripheral swelling — Feeling: Good

Free text: Arm became swollen, and inflamed again. Several days of unusual fatigue. Better again.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-26
Dose 2 — Moderna
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Neck pain — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Neck hurts

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to work

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-02
Survey response — day 35, dose 2
MedDRA: Ligament disorder, Tendon disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Ive had trouble with tendon or ligament in my foot and notice its worsening. Made MD appt next week, but dont think due to vaccine (?).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-09
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-28
Survey response — 3 months, dose 2
MedDRA: Tendonitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Tendinitis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-06-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-27
Survey response — day 0, dose 3
MedDRA: Unevaluable event — Feeling: Good

Free text: Just had shot 15 minutes ago.

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Unevaluable event — Feeling: Fair · Fever · Fatigue or tiredness

Free text: My normal temp is usually 97.4-97.8

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

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

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-11
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-17
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-11-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-10
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-26
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-04-27
Survey response — 6 months, dose 3
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-11-03
Dose 4 — Moderna
2022-11-03
Health check-in — day 0, dose 4
Feeling: Good · Site: Itching · None

Adult check-in
2022-11-03
Survey response — 12 months, dose 3
MedDRA: Knee arthroplasty, Office visit, Surgery — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Had total knee replacement. · Healthcare visit (other): Output surgery.

MedDRA releases: 2024-11 · check-in free text available
2022-11-03
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-04
Survey response — days 1–6 daily, dose 4
MedDRA: Dizziness — Feeling: Fair · Site: Itching · Fever · Fatigue or tiredness

Free text: Dizziness

MedDRA releases: 2024-11 · check-in free text available
2022-11-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2022-11-06
Survey response — days 1–6 daily, dose 4
MedDRA: Dizziness — Feeling: Fair · Fatigue or tiredness

Free text: Mild dizziness

MedDRA releases: 2024-11 · check-in free text available
2022-11-08
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-11-10
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-11-17
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-12-03
Survey response — day 28, dose 4
MedDRA: Malaise — Feeling: Fair · Be unable to do your normal daily activities

Free text: A cold?, first time sick in 3yrs.

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-12-17
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-02-05
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-05-04
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-27	Moderna
2	2021-02-26	Moderna
3	2021-10-27	Moderna	No
4	2022-11-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-02	Successful 2021-06-14	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-05-28	Successful 2021-06-14	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-11-03	Successful 2022-11-04	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-28

Systemic reaction (other): Am retired so able to decrease activity.

Release 3 — day 14, dose 1

2021-02-10

Symptoms: Arm became swollen, and inflamed again. Several days of unusual fatigue. Better again.

Release 4 — days 1–6 daily, dose 2

2021-02-27

Systemic reaction (other): Neck hurts

Release 6 — day 35, dose 2

2021-04-02

Symptoms: Ive had trouble with tendon or ligament in my foot and notice its worsening. Made MD appt next week, but dont think due to vaccine (?).

Release 8 — 3 months, dose 2

2021-05-28

Symptoms: Tendinitis

Release 10 — day 0, dose 3

2021-10-27

Systemic reaction (other): Just had shot 15 minutes ago.

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): My normal temp is usually 97.4-97.8

Release 11 — 6 months, dose 3

2022-04-27

Symptoms: Fatigue

Release 12 — 12 months, dose 3

2022-11-03

Symptoms: Had total knee replacement.

Healthcare visit (other): Output surgery.

Release 12 — days 1–6 daily, dose 4

2022-11-04

Systemic reaction (other): Dizziness

2022-11-06

Systemic reaction (other): Mild dizziness

Release 12 — day 28, dose 4

2022-12-03

Symptoms: A cold?, first time sick in 3yrs.

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	·	·	✓
HCVO	Surgery	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Knee arthroplasty	·	·	✓
SD	Ligament disorder	✓	✓	✓
SD	Malaise	·	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Tendon disorder	✓	✓	✓
SD	Tendonitis	✓	✓	✓
SRO	Decreased activity	✓	✓	✓
SRO	Dizziness	·	·	✓
SRO	Neck pain	✓	✓	✓
SRO	Unevaluable event	·	·	✓

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