Y96-65138-68208

4 vaccinations 8 coded responses 32 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 310 / GA
Registered: 2021-01-16

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

2020-12-31
Dose 1 — Moderna
2021-01-16
Registered in v-safe
2021-01-16
Survey response — day 14, dose 1
MedDRA: Chills, Fatigue, Pain in extremity, Pruritus — Feeling: Good

Free text: Days 1-6, 6-10 hrs of fatigue and chills each afternoon and evening. Days 1-13, sore arm. Days 11-15, itchy arm.

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

Adult check-in
2021-01-28
Dose 2 — Moderna
2021-01-28
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Nausea

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Nausea

Adult check-in
2021-02-04
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain, Itching · Nausea

Adult check-in
2021-02-11
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-30
Survey response — 6 months, dose 2
MedDRA: Angina pectoris, Cough, Diarrhoea, Fatigue, Pre-existing disease — Feeling: Good

Free text: Diarrhea caused by a known previous GI condition, angina caused by known previous heart condition, fatigue (?heart), mild cough (continued periodically since I had COVID-19 in March 2020).

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-30
Dose 3 — Moderna
2021-10-24
Survey response — day 21, dose 3
MedDRA: Chills, Fatigue, Pain in extremity, Pre-existing disease, Pyrexia — Feeling: Good · Be unable to work or attend school

Free text: Breakthrough infection with cough, chest pain, chills, fatigue. Later had reaction to 3rd dose of vaccine of fever, chills, arm pain, and fatigue.

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-04
Survey response — day 35, dose 3
MedDRA: Arthritis, Pre-existing disease — Feeling: Good

Free text: Arthritis in multiple joints- no idea what suddenly made it come back

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Survey response — day 42, dose 3
MedDRA: Arthritis, Pre-existing disease — Feeling: Good

Free text: Arthritis flare-up

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-02
Survey response — 6 months, dose 3
MedDRA: Exposure to SARS-CoV-2, Fatigue, Headache, Quarantine, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school

Free text: Unusual headache and fatigue for 2 weeks after 20 hours of close exposure without a mask to a Covid + person. Home test was negative but I stayed away from people. No lingering symptoms now.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Dose 4 — Moderna
2022-05-15
Health check-in — day 7, dose 4
Feeling: Good · Site: Itching · Diarrhea

Adult check-in
2022-05-16
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-23
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-30
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-06
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-13
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-03
Survey response — 3 months, dose 4
MedDRA: Bursitis, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bursitis- I belie it's unrelated to vaccine or Covid. · Healthcare visit (other): Appointment with physician

MedDRA releases: 2024-11 · check-in free text available
2022-08-03
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-04
Call 2 — Left Voicemail
2022-10-31
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-02
Survey response — 12 months, dose 4
MedDRA: Adverse drug reaction — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-05-02
Report sent to call center — 12 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-05-03
Call 1 — Left Voicemail
2023-05-03
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-31	Moderna
2	2021-01-28	Moderna
3	2021-09-30	Moderna	No
4	2022-05-02	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-08-03	Unsuccessful
2023-05-02	Unsuccessful

Free text

Release 2 — day 14, dose 1

2021-01-16

Symptoms: Days 1-6, 6-10 hrs of fatigue and chills each afternoon and evening. Days 1-13, sore arm. Days 11-15, itchy arm.

Release 9 — 6 months, dose 2

2021-07-30

Symptoms: Diarrhea caused by a known previous GI condition, angina caused by known previous heart condition, fatigue (?heart), mild cough (continued periodically since I had COVID-19 in March 2020).

Release 10 — day 21, dose 3

2021-10-24

Symptoms: Breakthrough infection with cough, chest pain, chills, fatigue. Later had reaction to 3rd dose of vaccine of fever, chills, arm pain, and fatigue.

Release 10 — day 35, dose 3

2021-11-04

Symptoms: Arthritis in multiple joints- no idea what suddenly made it come back

Release 10 — day 42, dose 3

2021-11-11

Symptoms: Arthritis flare-up

Release 11 — 6 months, dose 3

2022-04-02

Symptoms: Unusual headache and fatigue for 2 weeks after 20 hours of close exposure without a mask to a Covid + person. Home test was negative but I stayed away from people. No lingering symptoms now.

Release 12 — 3 months, dose 4

2022-08-03

Symptoms: Bursitis- I belie it's unrelated to vaccine or Covid.

Healthcare visit (other): Appointment with physician

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	·	·	✓
SD	Adverse drug reaction	·	·	✓
SD	Angina pectoris	✓	·	✓
SD	Arthritis	·	·	✓
SD	Bursitis	·	·	✓
SD	Chills	✓	✓	✓
SD	Cough	✓	·	✓
SD	Diarrhoea	✓	·	✓
SD	Exposure to SARS-CoV-2	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Pruritus	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Quarantine	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓

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