YF7-22900-30831

2 vaccinations 13 coded responses 21 check-ins 13 free-text entries 6 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 074 / NJ
Registered: 2021-01-20

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-01-20
Registered in v-safe
2021-01-20
Dose 1 — Moderna
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Joint swelling — Feeling: Good · Site: Pain, Swelling

Free text: Had chills no fever 14 hrs after injection lasting about 1 he also swelling was not at injection site but started about 3 inches below and extended to elbow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site swelling — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Still with minimal swelling below injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Swelling · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache · Be unable to do your normal daily activities

Adult check-in
2021-01-27
Survey response — day 7, dose 1
MedDRA: Injection site swelling — Feeling: Good · Site: Swelling

Free text: Still remain with mild swelling 3-4inches below the injection site and it extends to just above elbow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-10
Survey response — day 21, dose 1
MedDRA: Emergency care, Tachycardia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: In hospital tachycardia also working up for possible blood clot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 28, dose 1
MedDRA: Condition aggravated, Eosinophil count increased, Hospitalisation, Pre-existing disease, Pulmonary embolism — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Have History of HES my Eosinophils ct doubled between week 2 and 3 had PE now on Eliquis · Healthcare visit (other): Admitted 2/9-2/12/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-20
Dose 2 — Moderna
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Pain in extremity, Swelling — Feeling: Fair · Site: Swelling · Headache

Free text: Had arm pain first 2 days chills first night no fever very little swelling with second vaccine but swelling from first remains but know finally going down . Had my eosinophils checked prior to. Vaccine they were 620 Doctor will repeat at 3weeks post vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Peripheral swelling — Feeling: Fair · Fatigue or tiredness

Free text: Improvement in arm swelling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Very tired today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-06
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-13
Survey response — day 21, dose 2
MedDRA: Emergency care, Heart rate irregular — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Was in Emergency room today with irregular heartbeat. Premature atrial contractions was discharged this evening. On positive note eosinophils were normal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-20
Survey response — day 28, dose 2
MedDRA: Joint swelling, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Abnormal EKG ST changes awaiting results of MRI heart Improvement finally to swelling below 1st injection site still slightly present · Healthcare visit (other): Cardiologist 1month after hospitalization and Hospital Radiology for MRI

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-27
Survey response — day 35, dose 2
MedDRA: Fatigue, Hypertrophic cardiomyopathy, Medical counselling, Peripheral swelling — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Diagnosed this week with Hypertrophic cardiomyopathy. Have fatigue. Still with some residual swelling right arm below vaccine site and just above elbow not painful no reddness · Healthcare visit (other): Cardiologist office and testing at hospital

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-05
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-06
Call 1 — Left Voicemail
2021-08-23
Survey response — 6 months, dose 2
MedDRA: Atrial fibrillation, Emergency care, Office visit — 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: Symptoms: Afib which started on 6/20/2021 · Healthcare visit (other): Had Er visit then office visit

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-27
Call 1 — Left Voicemail
2022-02-20
Survey response — 12 months, dose 2
MedDRA: Macular pigmentation, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Macular pigmintation · Healthcare visit (other): DrOffice

MedDRA releases: 2024-11 · check-in free text available
2022-02-20
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Moderna
2	2021-02-20	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-02-17	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-03-13	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-03-20	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-03-27	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-23	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-20	Successful 2022-02-21	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): Had chills no fever 14 hrs after injection lasting about 1 he also swelling was not at injection site but started about 3 inches below and extended to elbow

2021-01-23

Systemic reaction (other): Still with minimal swelling below injection site

Release 2 — day 7, dose 1

2021-01-27

Systemic reaction (other): Still remain with mild swelling 3-4inches below the injection site and it extends to just above elbow

Release 4 — day 21, dose 1

2021-02-10

Symptoms: In hospital tachycardia also working up for possible blood clot

Release 4 — day 28, dose 1

2021-02-17

Symptoms: Have History of HES my Eosinophils ct doubled between week 2 and 3 had PE now on Eliquis

Healthcare visit (other): Admitted 2/9-2/12/21

Release 4 — days 1–6 daily, dose 2

2021-02-24

Systemic reaction (other): Had arm pain first 2 days chills first night no fever very little swelling with second vaccine but swelling from first remains but know finally going down . Had my eosinophils checked prior to. Vaccine they were 620 Doctor will repeat at 3weeks post vaccine

2021-02-25

Systemic reaction (other): Improvement in arm swelling

2021-02-26

Systemic reaction (other): Very tired today

Release 5 — day 21, dose 2

2021-03-13

Symptoms: Was in Emergency room today with irregular heartbeat. Premature atrial contractions was discharged this evening. On positive note eosinophils were normal.

Release 6 — day 28, dose 2

2021-03-20

Symptoms: Abnormal EKG ST changes awaiting results of MRI heart Improvement finally to swelling below 1st injection site still slightly present

Healthcare visit (other): Cardiologist 1month after hospitalization and Hospital Radiology for MRI

Release 6 — day 35, dose 2

2021-03-27

Symptoms: Diagnosed this week with Hypertrophic cardiomyopathy. Have fatigue. Still with some residual swelling right arm below vaccine site and just above elbow not painful no reddness

Healthcare visit (other): Cardiologist office and testing at hospital

Release 9 — 6 months, dose 2

2021-08-23

Symptoms: Afib which started on 6/20/2021

Healthcare visit (other): Had Er visit then office visit

Release 11 — 12 months, dose 2

2022-02-20

Symptoms: Macular pigmintation

Healthcare visit (other): DrOffice

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	Emergency care	✓	·	✓
HCVO	Hospitalisation	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Atrial fibrillation	✓	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Eosinophil count increased	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Heart rate irregular	✓	✓	✓
SD	Hypertrophic cardiomyopathy	✓	✓	✓
SD	Joint swelling	✓	✓	✓
SD	Macular pigmentation	·	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pulmonary embolism	✓	✓	✓
SD	Tachycardia	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Joint swelling	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Swelling	✓	✓	✓

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