Y9A-31141-47915

3 vaccinations 7 coded responses 25 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 325 / FL
Registered: 2021-01-26

Relationship: Self
Race: Asian
Ethnicity: N/A

Timeline

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

2021-01-24
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Muscle or body aches

Free text: Mild pain underneath the injection site (underarm)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-07
Survey response — day 14, dose 1
MedDRA: Erythema, Headache, Lymph node pain, Malaise, Pain in extremity, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: Sore arms, redness, fever, pain in the lymph nodes under arms of vaccine area, malaise, headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-21
Dose 2 — Moderna
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-23
Survey response — days 1–6 daily, dose 2
MedDRA: Incontinence — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Incontinence

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-03-03
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-07
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-14
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-21
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-24
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Neck pain — Feeling: Good · Be unable to do your normal daily activities

Free text: Pain in my right knee similar to arthritis? Also neck & shoulder pains not experienced before.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling, Itching · Headache

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-02
Survey response — day 7, dose 3
MedDRA: Eyelid rash — Feeling: Fair · Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Rash on my eye lids & under lowerLashes

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Survey response — day 21, dose 3
MedDRA: Arthritis, Dyspnoea, Headache, Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Facial rashes, knee joint's inflamed! Headaches, shortness of breathing

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Report sent to call center — day 21, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-17
Call 1 — Left Voicemail
2021-11-22
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-02
Survey response — day 35, dose 3
MedDRA: Hypersensitivity — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sudden allergies around my eyes- never had it before

MedDRA releases: 2024-11 · check-in free text available
2021-12-02
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-02
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-24	Moderna
2	2021-02-21	Moderna
3	2021-10-25	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-11-16	Unsuccessful
2021-12-02	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Mild pain underneath the injection site (underarm)

Release 3 — day 14, dose 1

2021-02-07

Symptoms: Sore arms, redness, fever, pain in the lymph nodes under arms of vaccine area, malaise, headaches

Release 4 — days 1–6 daily, dose 2

2021-02-23

Systemic reaction (other): Incontinence

Release 8 — 3 months, dose 2

2021-05-24

Symptoms: Pain in my right knee similar to arthritis? Also neck & shoulder pains not experienced before.

Release 10 — day 7, dose 3

2021-11-02

Systemic reaction (other): Rash on my eye lids & under lowerLashes

Release 10 — day 21, dose 3

2021-11-16

Symptoms: Facial rashes, knee joint's inflamed! Headaches, shortness of breathing

Release 10 — day 35, dose 3

2021-12-02

Symptoms: Sudden allergies around my eyes- never had it before

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	Arthritis	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Erythema	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	·	·	✓
SD	Lymph node pain	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	·	·	✓
SRO	Eyelid rash	·	·	✓
SRO	Incontinence	✓	✓	✓
SRO	Injection site pain	✓	✓	✓

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