YJL-24319-47713

4 vaccinations 10 coded responses 30 check-ins 9 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 606 / IL
Registered: 2021-01-25

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

2021-01-22
Dose 1 — Moderna
2021-01-25
Registered in v-safe
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-01-30
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Survey response — day 14, dose 1
MedDRA: Dyspepsia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Excruciating heartburn.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-21
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-02
Survey response — day 42, dose 2
MedDRA: Unevaluable event — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Had surgical induction for right clavicle 3/31.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — day 42, 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)
2021-05-21
Survey response — 3 months, dose 2
MedDRA: Balance disorder, Clavicle fracture, Fall, Pain, Rib fracture, Surgery — 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, Hospitalization

Free text: Symptoms: I fell and broke 7 ribs and right clavicle. Had to have surgery to repair clavicle. Very painful. My balance is not good. · Healthcare visit (other): Surgery

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-13
Call 3 — Left Voicemail
2021-08-23
Survey response — 6 months, dose 2
MedDRA: Gastrointestinal disorder, Headache — 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: Headaches, GI problemssurgery scheduled.

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)
2021-08-24
Call X — Left Voicemail
2021-08-25
Dose 3 — Moderna
2021-11-26
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-02-23
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-04-21
Dose 4 — Moderna
2022-04-25
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2022-04-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2022-04-27
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-04-28
Health check-in — day 7, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-05-06
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-05-12
Survey response — day 21, dose 4
MedDRA: Back pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: My lower back is excoriating painful.

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-05-26
Survey response — day 35, dose 4
MedDRA: Back pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe lower back pain.

MedDRA releases: 2024-11 · check-in free text available
2022-06-02
Survey response — day 42, dose 4
MedDRA: Eyelid ptosis, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Drooping right eyelid. Need to see a specialist per my Opthamologist.

MedDRA releases: 2024-11 · check-in free text available
2022-06-02
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-06-03
Call 2 — Left Voicemail
2022-06-03
Call 2 — Left Voicemail
2022-06-03
Call 2 — Left Voicemail
2022-06-03
Call 2 — Left Voicemail
2022-07-21
Survey response — 3 months, dose 4
MedDRA: Blood creatinine increased, Medical counselling — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: High creatinine level. Will retest and if still high will have kidney biopsy. · Healthcare visit (other): Phone

MedDRA releases: 2024-11 · check-in free text available
2022-07-21
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-07-22
Call 3 — Left Voicemail
2022-07-22
Call X — Left Voicemail
2022-07-22
Call 3 — Left Voicemail
2022-07-22
Call 3 — Left Voicemail
2022-07-22
Call 2 — Left Voicemail
2022-10-20
Survey response — 6 months, dose 4
MedDRA: Lymphadenopathy, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Runny nose and swollen glands.

MedDRA releases: 2024-11 · check-in free text available
2023-04-21
Survey response — 12 months, dose 4
MedDRA: Gastrointestinal disorder, Temporomandibular pain and dysfunction syndrome — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

MedDRA releases: 2024-11
2023-04-21
Report sent to call center — 12 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail
2023-04-24
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-19	Moderna
3	2021-08-25	Moderna	No
4	2022-04-21	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-02	Unsuccessful
2021-05-21	Unsuccessful
2021-08-23	Unsuccessful
2022-06-02	Unsuccessful
2022-07-21	Unsuccessful
2023-04-21	Unsuccessful

Free text

Release 3 — day 14, dose 1

2021-02-05

Symptoms: Excruciating heartburn.

Release 6 — day 42, dose 2

2021-04-02

Symptoms: Had surgical induction for right clavicle 3/31.

Release 8 — 3 months, dose 2

2021-05-21

Symptoms: I fell and broke 7 ribs and right clavicle. Had to have surgery to repair clavicle. Very painful. My balance is not good.

Healthcare visit (other): Surgery

Release 9 — 6 months, dose 2

2021-08-23

Symptoms: Headaches, GI problemssurgery scheduled.

Release 11 — day 21, dose 4

2022-05-12

Symptoms: My lower back is excoriating painful.

Release 11 — day 35, dose 4

2022-05-26

Symptoms: Severe lower back pain.

Release 11 — day 42, dose 4

2022-06-02

Symptoms: Drooping right eyelid. Need to see a specialist per my Opthamologist.

Release 12 — 3 months, dose 4

2022-07-21

Symptoms: High creatinine level. Will retest and if still high will have kidney biopsy.

Healthcare visit (other): Phone

Release 12 — 6 months, dose 4

2022-10-20

Symptoms: Runny nose and swollen glands.

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	Medical counselling	·	·	✓
HCVO	Surgery	✓	✓	✓
SD	Back pain	·	·	✓
SD	Balance disorder	✓	✓	✓
SD	Blood creatinine increased	·	·	✓
SD	Clavicle fracture	✓	✓	✓
SD	Dyspepsia	✓	✓	✓
SD	Eyelid ptosis	·	·	✓
SD	Fall	✓	✓	✓
SD	Gastrointestinal disorder	✓	·	✓
SD	Headache	✓	·	✓
SD	Lymphadenopathy	·	·	✓
SD	Office visit	·	·	✓
SD	Pain	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Rib fracture	✓	✓	✓
SD	Surgery	✓	✓	✓
SD	Temporomandibular pain and dysfunction syndrome	·	·	✓
SD	Unevaluable event	✓	✓	✓

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