YJL-10784-57475

4 vaccinations 13 coded responses 37 check-ins 13 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 199 / DE
Registered: 2021-10-15

Relationship: Self
Race: Other
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-10-15
Registered in v-safe
2021-10-15
Dose 1 — Moderna
2021-10-15
Survey response — day 0, dose 1
MedDRA: Eructation, Gastrooesophageal reflux disease — Feeling: Good · Site: Pain · Headache

Free text: Acid reflux and burping

MedDRA releases: 2024-11 · check-in free text available
2021-10-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-17
Survey response — days 1–6 daily, dose 1
MedDRA: Gastrooesophageal reflux disease — Feeling: Good · Site: Pain · Headache

Free text: Acid reflux

MedDRA releases: 2024-11 · check-in free text available
2021-10-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-21
Survey response — days 1–6 daily, dose 1
MedDRA: Eyelid pain, Eyelids pruritus — Feeling: Good · Headache

Free text: Eyelids itchy and sore

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — day 14, dose 1
MedDRA: Dysphonia, Oropharyngeal pain, Speech disorder — Feeling: Good · Be unable to do your normal daily activities

Free text: Sore throat, hoarseness, difficulty speaking, especially when singing

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-11-12
Dose 2 — Moderna
2021-11-12
Survey response — day 0, dose 2
MedDRA: Gastrooesophageal reflux disease — Feeling: Good · Nausea

Free text: Acid reflux

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-11-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-11-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-11-22
Survey response — day 7, dose 2
MedDRA: Eye pain, Vision blurred — Feeling: Good · Chills

Free text: On and off stinging of eyes and blurred vision

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Survey response — day 14, dose 2
MedDRA: Headache — Feeling: Fair

Free text: Bad headache

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Survey response — day 21, dose 2
MedDRA: Muscle spasms — Feeling: Fair · Be unable to do your normal daily activities

Free text: Painful back spasms

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-12-18
Survey response — day 35, dose 2
MedDRA: Arthralgia, Muscle spasms, Office visit, Pollakiuria, Rhinorrhoea — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Joint pain, back spasms, runny noise and frequent urination · Healthcare visit (other): Chiropractor

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
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)
2021-12-23
Call 1 — Requested Callback
2021-12-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-12-30
Callback requested for
3:00PM ET
2021-12-30
Call successful
Participant prefers to complete VAERS report online
2022-02-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-05-16
Dose 3 — Moderna
2022-05-16
Survey response — 6 months, dose 2
MedDRA: Blood cholesterol increased, Hypertension — Feeling: Good

Free text: High blood pressure and high cholesterol

MedDRA releases: 2024-11 · check-in free text available
2022-06-29
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-08-15
Survey response — 3 months, dose 3
MedDRA: Blood pressure abnormal, Fatigue, Pruritus, Vision blurred — Feeling: Good · Be unable to do your normal daily activities

Free text: Blurring of vision, Itchy skin, eradicate blood pressure, fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-09-23
Dose 4 — Moderna
2022-09-23
Survey response — day 0, dose 4
MedDRA: Oesophageal pain — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Burning sensation down esophagus

MedDRA releases: 2024-11 · check-in free text available
2022-09-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-25
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-27
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fever · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-09-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Fatigue or tiredness

Adult check-in
2022-10-01
Health check-in — day 7, dose 4
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2022-10-07
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-14
Survey response — day 21, dose 4
MedDRA: Arthralgia, Back pain, Hyperhidrosis, Muscle spasms — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe back and joint pains, cramping and heavy perspiration but no temperature.

MedDRA releases: 2024-11 · check-in free text available
2022-10-21
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-28
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-08
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-23
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-26
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-10-15	Moderna	No
2	2021-11-12	Moderna	No
3	2022-05-16	Moderna	No
4	2022-09-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-18	Successful 2021-12-30	Participant prefers to complete VAERS report online

Free text

Release 10 — day 0, dose 1

2021-10-15

Systemic reaction (other): Acid reflux and burping

Release 10 — days 1–6 daily, dose 1

2021-10-17

Systemic reaction (other): Acid reflux

2021-10-21

Systemic reaction (other): Eyelids itchy and sore

Release 10 — day 14, dose 1

2021-10-31

Symptoms: Sore throat, hoarseness, difficulty speaking, especially when singing

Release 10 — day 0, dose 2

2021-11-12

Systemic reaction (other): Acid reflux

Release 10 — day 7, dose 2

2021-11-22

Systemic reaction (other): On and off stinging of eyes and blurred vision

Release 10 — day 14, dose 2

2021-11-26

Symptoms: Bad headache

Release 10 — day 21, dose 2

2021-12-03

Symptoms: Painful back spasms

Release 10 — day 35, dose 2

2021-12-18

Symptoms: Joint pain, back spasms, runny noise and frequent urination

Healthcare visit (other): Chiropractor

Release 11 — 6 months, dose 2

2022-05-16

Symptoms: High blood pressure and high cholesterol

Release 12 — 3 months, dose 3

2022-08-15

Symptoms: Blurring of vision, Itchy skin, eradicate blood pressure, fatigue

Release 12 — day 0, dose 4

2022-09-23

Systemic reaction (other): Burning sensation down esophagus

Release 12 — day 21, dose 4

2022-10-14

Symptoms: Severe back and joint pains, cramping and heavy perspiration but no temperature.

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	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Blood cholesterol increased	·	·	✓
SD	Blood pressure abnormal	·	·	✓
SD	Dysphonia	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Hyperhidrosis	·	·	✓
SD	Hypertension	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pollakiuria	·	·	✓
SD	Pruritus	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Speech disorder	·	·	✓
SD	Vision blurred	·	·	✓
SRO	Eructation	·	·	✓
SRO	Eye pain	·	·	✓
SRO	Eyelid pain	·	·	✓
SRO	Eyelids pruritus	·	·	✓
SRO	Gastrooesophageal reflux disease	·	·	✓
SRO	Oesophageal pain	·	·	✓
SRO	Vision blurred	·	·	✓

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