YDZ-30400-49609

3 vaccinations 11 coded responses 34 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 46-50
ZIP prefix: 622 / IL
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Health check-in — day 0, dose 1
Feeling: Good · Fever · Chills

Adult check-in
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fever · Fatigue or tiredness

Adult check-in
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Dose 2 — Moderna
2021-02-01
Survey response — day 0, dose 2
MedDRA: Feeling cold — Feeling: Good · Site: Pain

Free text: Not chills, just a cold feeling

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

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site lymphadenopathy, Lymphadenopathy — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Muscle or body aches

Free text: Largely swollen lymph node along collarbone at base of neck on the side of the injections

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain · Fever · Headache

Free text: Large swollen lymph node along collarbone on side of injection

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

Free text: Swollen lymph node along collar bone on side of injections

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Still have swollen lymph node along collar bone on side where injection given

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 · Headache

Adult check-in
2021-02-08
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-04
Survey response — 6 months, dose 2
MedDRA: Arthritis — Feeling: Fair

Free text: Worsening arthritis

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-01-05
Dose 3 — Moderna
2022-01-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness

Adult check-in
2022-01-07
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain · Fever · Muscle or body aches

Free text: Swollen lymph nodes along collarbone and under armpit

MedDRA releases: 2024-11 · check-in free text available
2022-01-08
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Swollen lymph nodes along collarbone and arm pit

MedDRA releases: 2024-11 · check-in free text available
2022-01-09
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Swollen lymph nodes along collarbone and armpit

MedDRA releases: 2024-11 · check-in free text available
2022-01-14
Health check-in — day 7, dose 3
Feeling: Good · Headache

Adult check-in
2022-01-19
Survey response — day 14, dose 3
MedDRA: Effusion, Mucosal disorder, Office visit, Oropharyngeal oedema, Tympanic membrane disorder — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Developed bulging tympanic membrane with effusion on left side along with abnormal mucous membranes and edema in posterior oropharynx all on the left side (vaccination side) · Healthcare visit (other): Doctor's office visit

MedDRA releases: 2024-11 · check-in free text available
2022-01-19
Report sent to call center — day 14, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-01-20
Call 1 — Left Voicemail
2022-01-26
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-02-02
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-09
Survey response — day 35, dose 3
MedDRA: COVID-19 — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Covid diagnosis

MedDRA releases: 2024-11 · check-in free text available
2022-02-16
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-04-06
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-01	Moderna
3	2022-01-05	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-19	Unsuccessful

Free text

Release 3 — day 0, dose 2

2021-02-01

Systemic reaction (other): Not chills, just a cold feeling

Release 3 — days 1–6 daily, dose 2

2021-02-03

Systemic reaction (other): Largely swollen lymph node along collarbone at base of neck on the side of the injections

2021-02-04

Systemic reaction (other): Large swollen lymph node along collarbone on side of injection

2021-02-05

Systemic reaction (other): Swollen lymph node along collar bone on side of injections

2021-02-06

Systemic reaction (other): Still have swollen lymph node along collar bone on side where injection given

Release 9 — 6 months, dose 2

2021-08-04

Symptoms: Worsening arthritis

Release 10 — days 1–6 daily, dose 3

2022-01-07

Systemic reaction (other): Swollen lymph nodes along collarbone and under armpit

2022-01-08

Systemic reaction (other): Swollen lymph nodes along collarbone and arm pit

2022-01-09

Systemic reaction (other): Swollen lymph nodes along collarbone and armpit

Release 10 — day 14, dose 3

2022-01-19

Symptoms: Developed bulging tympanic membrane with effusion on left side along with abnormal mucous membranes and edema in posterior oropharynx all on the left side (vaccination side)

Healthcare visit (other): Doctor's office visit

Release 11 — day 35, dose 3

2022-02-09

Symptoms: Covid diagnosis

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	Arthritis	✓	·	✓
SD	COVID-19	·	·	✓
SD	Effusion	·	·	✓
SD	Mucosal disorder	·	·	✓
SD	Oropharyngeal oedema	·	·	✓
SD	Tympanic membrane disorder	·	·	✓
SRO	Feeling cold	✓	✓	✓
SRO	Injection site lymphadenopathy	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓

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