YFK-25705-37265

4 vaccinations 6 coded responses 16 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 974 / OR
Registered: 2021-03-25

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-03-24
Dose 1 — Moderna
2021-03-25
Registered in v-safe
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-01
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-21
Dose 2 — Moderna
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Dyspnoea, Ear pain — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Breathing cinstricted and ear pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-04-28
Survey response — day 7, dose 2
MedDRA: Arthralgia, Myalgia, Neck pain, Pain, Pain in extremity, Painful respiration, Self-medication — Feeling: Poor · Joint pains, Muscle or body aches · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Pain expanding fron neck/shoulder on Mon to scapula arm socket annd especially left chest muscles today. Any movement lifting change of position or touching is painful. Chest expansion to breathe hurts. · Healthcare visit (other): Tried to get appt but no availability. Sent to urgent care which refused to see me saying it could be vaccine/neurological. They said go to ER which I didnt have money for so I am at home taking ibuprofen. Prior to Monday no shoulder chest

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-05
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-12
Survey response — day 21, dose 2
MedDRA: Ear pain, Headache, Pain in extremity — Feeling: Fair

Free text: Random unaccountable pains...left ear/skull and upper right leg .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-28
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-04
Survey response — day 42, dose 2
MedDRA: Anxiety, Depression — Feeling: Fair · 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: Depression/anxiety

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-23
Survey response — 3 months, dose 2
MedDRA: Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Urinary track infection.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-23
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-28
Call successful
Participant prefers to complete VAERS report online
2021-10-23
Survey response — 6 months, dose 2
MedDRA: Abdominal discomfort — Feeling: Good

Free text: Intestinal discomfort

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Dose 3 — Moderna
2022-04-07
Dose 4 — Moderna
2022-10-06
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-24	Moderna
2	2021-04-21	Moderna
3	2021-11-04	Moderna	No
4	2022-04-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-28	Successful	Participant prefers to complete VAERS report online
2021-06-04	Successful	Participant prefers to complete VAERS report online
2021-07-23	Successful 2021-07-28	Participant prefers to complete VAERS report online

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-23

Systemic reaction (other): Breathing cinstricted and ear pain

Release 8 — day 7, dose 2

2021-04-28

Systemic reaction (other): Pain expanding fron neck/shoulder on Mon to scapula arm socket annd especially left chest muscles today. Any movement lifting change of position or touching is painful. Chest expansion to breathe hurts.

Healthcare visit (other): Tried to get appt but no availability. Sent to urgent care which refused to see me saying it could be vaccine/neurological. They said go to ER which I didnt have money for so I am at home taking ibuprofen. Prior to Monday no shoulder chest

Release 8 — day 21, dose 2

2021-05-12

Symptoms: Random unaccountable pains...left ear/skull and upper right leg .

Release 8 — day 42, dose 2

2021-06-04

Symptoms: Depression/anxiety

Release 9 — 3 months, dose 2

2021-07-23

Symptoms: Urinary track infection.

Release 10 — 6 months, dose 2

2021-10-23

Symptoms: Intestinal discomfort

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	Self-medication	✓	✓	✓
SD	Abdominal discomfort	·	·	✓
SD	Anxiety	✓	✓	✓
SD	Depression	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Urinary tract infection	✓	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Painful respiration	✓	✓	✓

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