YEN-31264-49623

3 vaccinations 9 coded responses 36 check-ins 9 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 600 / IL
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

2021-01-16
Registered in v-safe
2021-01-16
Dose 1 — Moderna
2021-01-16
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-17
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-30
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-13
Dose 2 — Moderna
2021-02-13
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Abdominal pain

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-20
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-06
Survey response — day 21, dose 2
MedDRA: Constipation — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Constipation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Report sent to call center — day 21, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-20
Survey response — day 35, dose 2
MedDRA: White blood cell count — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: High white count. (22) hemoglobin 10.3

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 35, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-27
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-15
Survey response — 3 months, dose 2
MedDRA: Pneumonia — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Pneumonia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-06-23
Call 1 — Left Voicemail
2021-06-25
Call 2 — Left Voicemail
2021-08-16
Survey response — 6 months, dose 2
MedDRA: Joint dislocation — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: 2nd hip displacement since June 10th. Will have 2nd hip repair surgery 8/17

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-23
Dose 3 — Moderna
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness · Fatigue or tiredness

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Rheumatoid arthritis — Feeling: Good · Fatigue or tiredness

Free text: RA symptoms

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — day 7, dose 3
MedDRA: Rheumatoid arthritis — Feeling: Good · Muscle or body aches

Free text: RA

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Survey response — day 14, dose 3
MedDRA: Fatigue — Feeling: Poor · Be unable to do your normal daily activities

Free text: Exhaustion

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-24
Survey response — 6 months, dose 3
MedDRA: Pneumonia — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Lung infection

MedDRA releases: 2024-11 · check-in free text available
2022-04-24
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-04-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-26
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-23
Survey response — 12 months, dose 3
MedDRA: Adverse reaction, Gastrointestinal disorder, Nausea, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: I have been having a problem with digestion. I feel nauseous half of the day. Because of this I put off Getting my next injection. And my flu shot. However I did get the flu shot this past week and did not have a very good reaction to it. · Healthcare visit (other): I have had many tests prescribed by doctors to discover what my problem is

MedDRA releases: 2024-11 · check-in free text available
2022-10-23
Report sent to call center — 12 months, dose 3
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)
2022-10-25
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-16	Moderna
2	2021-02-13	Moderna
3	2021-10-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-17	priority 2/3
2021-03-06	Successful 2022-04-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-03-20	Successful 2022-04-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-05-15	Successful 2021-06-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-24	Successful 2022-04-26	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-23	Successful 2022-10-25	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — day 21, dose 2

2021-03-06

Symptoms: Constipation

Release 6 — day 35, dose 2

2021-03-20

Symptoms: High white count. (22) hemoglobin 10.3

Release 8 — 3 months, dose 2

2021-05-15

Symptoms: Pneumonia

Release 9 — 6 months, dose 2

2021-08-16

Symptoms: 2nd hip displacement since June 10th. Will have 2nd hip repair surgery 8/17

Release 10 — days 1–6 daily, dose 3

2021-10-28

Systemic reaction (other): RA symptoms

Release 10 — day 7, dose 3

2021-11-01

Systemic reaction (other): RA

Release 10 — day 14, dose 3

2021-11-07

Symptoms: Exhaustion

Release 11 — 6 months, dose 3

2022-04-24

Symptoms: Lung infection

Release 12 — 12 months, dose 3

2022-10-23

Symptoms: I have been having a problem with digestion. I feel nauseous half of the day. Because of this I put off Getting my next injection. And my flu shot. However I did get the flu shot this past week and did not have a very good reaction to it.

Healthcare visit (other): I have had many tests prescribed by doctors to discover what my problem is

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	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Constipation	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Joint dislocation	✓	·	✓
SD	Nausea	·	·	✓
SD	Pneumonia	✓	✓	✓
SD	White blood cell count	✓	✓	✓
SRO	Rheumatoid arthritis	·	·	✓

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