YD4-30784-36250

4 vaccinations 8 coded responses 50 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 950 / CA
Registered: 2021-03-21

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

2021-03-21
Registered in v-safe
2021-03-21
Dose 1 — Moderna
2021-03-21
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Nausea

Adult check-in
2021-03-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Nausea

Adult check-in
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-03-28
Health check-in — day 7, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-19
Dose 2 — Moderna
2021-04-19
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Fatigue or tiredness

Adult check-in
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Neck pain — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Side of neck pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-22
Survey response — days 1–6 daily, dose 2
MedDRA: Neck pain — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Still slight neck pain, side of neck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache · Be unable to do your normal daily activities

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-04-26
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-05-03
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-10
Survey response — day 21, dose 2
MedDRA: Joint swelling, Skin discolouration, Skin texture abnormal, Skin ulcer, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Left elbow swollen, discolored, and with a large ulcer or sore in the center. Skin under eye in tear trough area turned white and texture changed. · Healthcare visit (other): I'm going to see my primary care doctor tomorrow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-19
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-18
Survey response — 6 months, dose 2
MedDRA: Asthenia, Chills, Dizziness, Fatigue, Heart rate increased, Malaise, Pyrexia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I had a flu vaccine on Friday 10/15 and became very ill from it later that night, with a fever of 101.5, shivering chills, and a high heart rate lasting until the next day. Weak, a bit dizzy, and extremely fatigued the next day, improving but tired.

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Dose 3 — Moderna
2021-12-12
Survey response — days 1–6 daily, dose 3
MedDRA: Chills, Fatigue, Pain in extremity, Pyrexia — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I didn't have any symptoms other than fatigue and mild arm soreness today, but the day after my injection (on the 10th) I had a fever and slight chills.

MedDRA releases: 2024-11 · check-in free text available
2021-12-15
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-12-17
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-12-24
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-07
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-14
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-21
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-03-11
Survey response — 3 months, dose 3
MedDRA: Uterine cancer, Uterine dilation and curettage — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Uterine cancer · Healthcare visit (other): Outpatient surgery for D&C

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-14
Call 1 — Left Voicemail
2022-06-12
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-12
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in
2022-12-16
Dose 4 — Moderna
2022-12-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-12-19
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-12-20
Survey response — days 1–6 daily, dose 4
MedDRA: Thinking abnormal — Feeling: Fair · Fatigue or tiredness

Free text: Foggy thinking

MedDRA releases: 2024-11 · check-in free text available
2022-12-21
Survey response — days 1–6 daily, dose 4
MedDRA: Brain fog — Feeling: Fair · Fatigue or tiredness

Free text: Foggy thinking

MedDRA releases: 2024-11 · check-in free text available
2022-12-22
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Headache, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-12-23
Health check-in — day 7, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-12-30
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2023-01-06
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2023-01-13
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2023-01-20
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2023-01-27
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2023-03-19
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2023-06-18
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-21	Moderna
2	2021-04-19	Moderna
3	2021-12-10	Moderna	No
4	2022-12-16	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-10	Unsuccessful
2022-03-11	Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-20

Systemic reaction (other): Side of neck pain

2021-04-22

Systemic reaction (other): Still slight neck pain, side of neck

Release 8 — day 21, dose 2

2021-05-10

Symptoms: Left elbow swollen, discolored, and with a large ulcer or sore in the center. Skin under eye in tear trough area turned white and texture changed.

Healthcare visit (other): I'm going to see my primary care doctor tomorrow

Release 10 — 6 months, dose 2

2021-10-18

Symptoms: I had a flu vaccine on Friday 10/15 and became very ill from it later that night, with a fever of 101.5, shivering chills, and a high heart rate lasting until the next day. Weak, a bit dizzy, and extremely fatigued the next day, improving but tired. cut off by CDC

Release 10 — days 1–6 daily, dose 3

2021-12-12

Systemic reaction (other): I didn't have any symptoms other than fatigue and mild arm soreness today, but the day after my injection (on the 10th) I had a fever and slight chills.

Release 11 — 3 months, dose 3

2022-03-11

Symptoms: Uterine cancer

Healthcare visit (other): Outpatient surgery for D&C

Release 12 — days 1–6 daily, dose 4

2022-12-20

Systemic reaction (other): Foggy thinking

2022-12-21

Systemic reaction (other): Foggy thinking

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	Unevaluable event	✓	✓	✓
HCVO	Uterine dilation and curettage	·	·	✓
SD	Asthenia	·	·	✓
SD	Chills	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	·	·	✓
SD	Heart rate increased	·	·	✓
SD	Joint swelling	✓	✓	✓
SD	Malaise	·	·	✓
SD	Pyrexia	·	·	✓
SD	Skin discolouration	✓	✓	✓
SD	Skin texture abnormal	✓	✓	✓
SD	Skin ulcer	✓	✓	✓
SD	Uterine cancer	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Chills	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Neck pain	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Pyrexia	·	·	✓
SRO	Thinking abnormal	·	·	✓

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