Y92-22963-94110

4 vaccinations 6 coded responses 25 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 121 / NY
Registered: 2021-01-16

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-16
Registered in v-safe
2021-01-29
Dose 1 — Moderna
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-05
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-14
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-26
Dose 2 — Moderna
2021-02-26
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-03-05
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Nausea, Diarrhea

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

Adult check-in
2021-03-20
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: Nephrolithiasis, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Kidney stones · Healthcare visit (other): Doctors office

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
2021-05-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-11
Call 1 — Left Voicemail
2021-08-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-26
Survey response — 12 months, dose 2
MedDRA: Amnesia, Arthralgia — Feeling: Fair

Free text: What is the breath short term memory loss joints have been aching

MedDRA releases: 2024-11 · check-in free text available
2022-05-23
Dose 3 — Moderna
2022-09-18
Dose 4 — Moderna
2022-09-25
Survey response — day 7, dose 4
MedDRA: Bell's palsy, Pre-existing disease — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Where I had Bell's palsy from COVID is acting up

MedDRA releases: 2024-11 · check-in free text available
2022-10-02
Survey response — day 14, dose 4
MedDRA: Hypoaesthesia eye, Office visit, Pre-existing disease, Skin tightness — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: My left eye feels numb and left cheek feels tight or like when I had Bell's palsy from COVID. It never really went away · Healthcare visit (other): Office visit

MedDRA releases: 2024-11 · check-in free text available
2022-10-02
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-03
Call 2 — Left Voicemail
2022-10-03
Call 1 — Left Voicemail
2022-10-03
Call successful
Participant prefers to complete VAERS report online
2022-10-03
Call successful
Completed over the phone
2022-10-10
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-10-19
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-10-23
Survey response — day 35, dose 4
MedDRA: Headache, Hypoaesthesia eye, Muscle twitching, Skin tightness, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: My left side of my face is tight cheek is twitching and my eye feels like it has numbness on the eye. Have a headache for 3 days. · Healthcare visit (other): Have a doctors appointment in office

MedDRA releases: 2024-11 · check-in free text available
2022-10-23
Report sent to call center — day 35, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-25
Call 1 — Left Voicemail
2022-10-25
Call successful
Completed over the phone
2022-10-30
Health check-in — day 42, dose 4
Feeling: Poor

Adult check-in
2022-12-18
Survey response — 3 months, dose 4
MedDRA: Headache, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Bad headaches sinus

MedDRA releases: 2024-11 · check-in free text available
2022-12-18
Report sent to call center — 3 months, dose 4
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)
2022-12-19
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-02-26	Moderna
3	2022-05-23	Moderna	No
4	2022-09-18	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-02	Successful 2022-10-03	Participant prefers to complete VAERS report online
2022-10-02	Successful 2022-10-03	Completed over the phone
2022-10-23	Successful 2022-10-25	Completed over the phone
2022-12-18	Unsuccessful

Free text

Release 6 — day 35, dose 2

2021-04-02

Symptoms: Kidney stones

Healthcare visit (other): Doctors office

Release 11 — 12 months, dose 2

2022-02-26

Symptoms: What is the breath short term memory loss joints have been aching

Release 12 — day 7, dose 4

2022-09-25

Systemic reaction (other): Where I had Bell's palsy from COVID is acting up

Release 12 — day 14, dose 4

2022-10-02

Symptoms: My left eye feels numb and left cheek feels tight or like when I had Bell's palsy from COVID. It never really went away

Healthcare visit (other): Office visit

Release 12 — day 35, dose 4

2022-10-23

Symptoms: My left side of my face is tight cheek is twitching and my eye feels like it has numbness on the eye. Have a headache for 3 days.

Healthcare visit (other): Have a doctors appointment in office

Release 12 — 3 months, dose 4

2022-12-18

Symptoms: Bad headaches sinus

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	Unevaluable event	·	·	✓
SD	Amnesia	·	·	✓
SD	Arthralgia	·	·	✓
SD	Headache	·	·	✓
SD	Hypoaesthesia eye	·	·	✓
SD	Muscle twitching	·	·	✓
SD	Nephrolithiasis	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Skin tightness	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Bell's palsy	·	·	✓
SRO	Pre-existing disease	·	·	✓

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