YAP-13388-93183

5 vaccinations 9 coded responses 33 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 936 / CA
Registered: 2021-01-26

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

2021-01-08
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-29
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: Unevaluable event — Feeling: Good

Free text: Just got this evening

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: The pain I experience is in the areas that I have chronic pain in, my rt ankle and rt knee and my hands

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-02-11
Health check-in — day 7, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-02-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-04
Survey response — day 28, dose 2
MedDRA: Abdominal discomfort, Headache, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Stomach upset, headache, more hand pain than usual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
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
2021-05-06
Survey response — 3 months, dose 2
MedDRA: Blister, Headache — Feeling: Good

Free text: HeadachesAlso have broken out with herpes type blisters on buttocks several times. I had chicken pox as child and cold sores growing up. Felt and acted like those.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-05
Survey response — 6 months, dose 2
MedDRA: Carpal tunnel decompression — Feeling: Good · Be unable to do your normal daily activities

Free text: Rt carpal tunnel release, etc, blood work for hematologist

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-29
Dose 3 — Moderna
2022-02-04
Survey response — 12 months, dose 2
MedDRA: Adverse reaction — Feeling: Good

Free text: Just using my inhaler more,

MedDRA releases: 2024-11 · check-in free text available
2022-04-21
Dose 4 — Moderna
2022-09-22
Dose 5 — Moderna
Co-administered: Flu
2022-09-22
Health check-in — day 0, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-09-23
Survey response — days 1–6 daily, dose 5
MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Slight shortness of breath, enough to use inhaler

MedDRA releases: 2024-11 · check-in free text available
2022-09-24
Survey response — days 1–6 daily, dose 5
MedDRA: Abdominal discomfort, Blood glucose increased, Self-medication — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Upset stomach but able to eat, tums helped, blood sugars elevated

MedDRA releases: 2024-11 · check-in free text available
2022-09-25
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-09-26
Survey response — days 1–6 daily, dose 5
MedDRA: Blood glucose abnormal — Feeling: Good

Free text: My blood sugar is back in normal range this sm

MedDRA releases: 2024-11 · check-in free text available
2022-09-27
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-09-28
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-09-29
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-06
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-13
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-20
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-10-27
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-03
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-22
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-03-23
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna
2	2021-02-04	Moderna
3	2021-10-29	Moderna	No
4	2022-04-21	Moderna	No
5	2022-09-22	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-03-04	Successful 2021-10-18	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 3 — day 0, dose 2

2021-02-04

Systemic reaction (other): Just got this evening

Release 3 — days 1–6 daily, dose 2

2021-02-06

Systemic reaction (other): The pain I experience is in the areas that I have chronic pain in, my rt ankle and rt knee and my hands

Release 5 — day 28, dose 2

2021-03-04

Symptoms: Stomach upset, headache, more hand pain than usual

Release 8 — 3 months, dose 2

2021-05-06

Symptoms: HeadachesAlso have broken out with herpes type blisters on buttocks several times. I had chicken pox as child and cold sores growing up. Felt and acted like those.

Release 9 — 6 months, dose 2

2021-08-05

Symptoms: Rt carpal tunnel release, etc, blood work for hematologist

Release 11 — 12 months, dose 2

2022-02-04

Symptoms: Just using my inhaler more,

Release 12 — days 1–6 daily, dose 5

2022-09-23

Systemic reaction (other): Slight shortness of breath, enough to use inhaler

2022-09-24

Systemic reaction (other): Upset stomach but able to eat, tums helped, blood sugars elevated

2022-09-26

Systemic reaction (other): My blood sugar is back in normal range this sm

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	Abdominal discomfort	✓	✓	✓
SD	Adverse reaction	·	·	✓
SD	Blister	✓	✓	✓
SD	Carpal tunnel decompression	✓	·	✓
SD	Headache	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SRO	Abdominal discomfort	·	·	✓
SRO	Blood glucose abnormal	·	·	✓
SRO	Blood glucose increased	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Self-medication	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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