YJ2-86973-45891

2 vaccinations 5 coded responses 21 check-ins 5 free-text entries 5 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 076 / NJ
Registered: 2021-01-19

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-19
Registered in v-safe
2021-01-19
Dose 1 — Moderna
2021-01-19
Health check-in — day 0, dose 1
Feeling: Good · Site: Swelling · Fatigue or tiredness

Adult check-in
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Pyrexia, SARS-CoV-2 test negative — Feeling: Fair · Site: Pain, 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, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Fever 101.2 -102.1 on 1/20/21-1/21/21. 98.1 today 1/22/21 · Healthcare visit (other): Rapid COVID test was recommended 1/22/21 am negative

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Report sent to call center — days 1–6 daily, dose 1
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)
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness, Diarrhea

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

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

Adult check-in
2021-01-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-16
Dose 2 — Moderna
2021-02-16
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Specialist consultation — Feeling: Fair · Fatigue or tiredness, Diarrhea, Abdominal pain · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Primary Dr appointment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-23
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-02
Survey response — day 14, dose 2
MedDRA: Unevaluable event — Feeling: Fair · 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, Emergency room or emergency department visit, Hospitalization

Free text: Appendectomy on 2/23/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Report sent to call center — day 14, 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)
2021-03-09
Survey response — day 21, dose 2
MedDRA: Appendicectomy, Arthralgia, Emergency care, Erythema nodosum, Pain in extremity, Pyrexia, Rash, Rash macular — Feeling: Fair · Be unable to work, 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: ER 2/22 & Appendectomy 2/23/21. ER 3/7/21 fever, pain in both legs, painful purple pink blotches both legs, pain inside Elbow areas. Dx Erythema Nodosum. 3/9/21 Infectious disease Dr (b)(6) took skin biopsy of right leg. Awaiting results

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
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)
2021-03-16
Survey response — day 28, dose 2
MedDRA: Erythema nodosum, Office visit — Feeling: Fair · 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: Symptoms: Erythema Nodosum · Healthcare visit (other): Saw infectious disease specialist & he did skin biopsy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Report sent to call center — day 28, 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)
2021-03-23
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-17
Call 1 — Left Voicemail
2021-05-20
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-16	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-22	Unsuccessful
2021-02-22	Unsuccessful
2021-03-02	Unsuccessful
2021-03-09	Unsuccessful
2021-03-16	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): Fever 101.2 -102.1 on 1/20/21-1/21/21. 98.1 today 1/22/21

Healthcare visit (other): Rapid COVID test was recommended 1/22/21 am negative

Release 4 — days 1–6 daily, dose 2

2021-02-22

Healthcare visit (other): Primary Dr appointment

Release 4 — day 14, dose 2

2021-03-02

Symptoms: Appendectomy on 2/23/21

Release 5 — day 21, dose 2

2021-03-09

Symptoms: ER 2/22 & Appendectomy 2/23/21. ER 3/7/21 fever, pain in both legs, painful purple pink blotches both legs, pain inside Elbow areas. Dx Erythema Nodosum. 3/9/21 Infectious disease Dr (b)(6) took skin biopsy of right leg. Awaiting results

redacted (b)(6)

Release 5 — day 28, dose 2

2021-03-16

Symptoms: Erythema Nodosum

Healthcare visit (other): Saw infectious disease specialist & he did skin biopsy

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	✓	✓	✓
HCVO	SARS-CoV-2 test negative	✓	✓	✓
HCVO	Specialist consultation	✓	✓	✓
SD	Appendicectomy	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Erythema nodosum	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash macular	✓	✓	✓
SD	Skin discolouration	○	○	○
SD	Unevaluable event	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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