YJQ-28709-76103

4 vaccinations 6 coded responses 26 check-ins 6 free-text entries 1 call case

Sex: Female
Age at first dose: 31-35
ZIP prefix: 773 / TX
Registered: 2021-03-21

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

2021-03-03
Dose 1 — Moderna
2021-03-21
Registered in v-safe
2021-03-21
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site pain, Injection site swelling — Feeling: Fair

Free text: Large (approximately 4-5 inches diameter) red, swollen, painful spot at vaccine site from day after 1st dose which lasted about 10 days. Was sore like a bruise and hurt worse on movement of the arm above the head. Has now resolved.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-30
Dose 2 — Moderna
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · 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
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Diarrhea, Abdominal pain

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Headache, Fatigue or tiredness

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Fatigue or tiredness

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Fatigue or tiredness

Adult check-in
2021-04-09
Health check-in — day 7, dose 2
Feeling: Fair · Site: Itching · None

Adult check-in
2021-04-13
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-20
Survey response — day 21, dose 2
MedDRA: Muscle spasms, 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: Muscle spasms in left back/shoulder. Probably unrelated. Currently day 4 of symptoms. Sought treatment on day 3, prescribed muscle relaxer.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
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)
2021-04-27
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-28
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-04
Dose 3 — Moderna
Co-administered: Flu
2021-10-28
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-01
Survey response — day 28, dose 3
MedDRA: Medical observation, Pruritus — Feeling: Good

Free text: Itching (full body) - began after starting a new medication (Humira). Being monitored by allergist and rheumatologist.

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-11-15
Survey response — day 42, dose 3
MedDRA: Pre-existing disease, Sinus congestion — Feeling: Good

Free text: Sinus congestion - consistent with known ragweed seasonal allergies. Began regualr allergy medication as per standing doctor's instructions.

MedDRA releases: 2024-11 · check-in free text available
2022-01-03
Survey response — 3 months, dose 3
MedDRA: Ear pain, Exposure to SARS-CoV-2, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test, SARS-CoV-2 test negative, Sinus congestion — Feeling: Fair

Free text: Sore throat, nasal congestion, sinus congestion, ear pain. Had COVID exposure on Dec 26th. Neg home test 31st. Awaiting PCR test this thurs.

MedDRA releases: 2024-11 · check-in free text available
2022-04-04
Call 1 — Requested Callback
2022-04-05
Callback requested for
07:00PM ET
2022-04-06
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-06
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-09-16
Dose 4 — Moderna
Co-administered: Flu:Tetanus
2022-09-25
Survey response — day 7, dose 4
MedDRA: Injection site urticaria — Feeling: Good · Site: Redness, Swelling · Fatigue or tiredness

Free text: Hive at site of a different injection (leg) is worse than usual. Sign immune system is active maybe?

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-28
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-18
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-03-30	Moderna
3	2021-10-04	Moderna	Flu
4	2022-09-16	Moderna	Flu:Tetanus

Call center

Reported	Outcome	VAERS-related outcome
2021-04-20	Successful 2022-04-06	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 6 — day 14, dose 1

2021-03-21

Symptoms: Large (approximately 4-5 inches diameter) red, swollen, painful spot at vaccine site from day after 1st dose which lasted about 10 days. Was sore like a bruise and hurt worse on movement of the arm above the head. Has now resolved.

Release 7 — day 21, dose 2

2021-04-20

Symptoms: Muscle spasms in left back/shoulder. Probably unrelated. Currently day 4 of symptoms. Sought treatment on day 3, prescribed muscle relaxer.

Release 10 — day 28, dose 3

2021-11-01

Symptoms: Itching (full body) - began after starting a new medication (Humira). Being monitored by allergist and rheumatologist.

Release 10 — day 42, dose 3

2021-11-15

Symptoms: Sinus congestion - consistent with known ragweed seasonal allergies. Began regualr allergy medication as per standing doctor's instructions.

Release 10 — 3 months, dose 3

2022-01-03

Symptoms: Sore throat, nasal congestion, sinus congestion, ear pain. Had COVID exposure on Dec 26th. Neg home test 31st. Awaiting PCR test this thurs.

Release 12 — day 7, dose 4

2022-09-25

Systemic reaction (other): Hive at site of a different injection (leg) is worse than usual. Sign immune system is active maybe?

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
SD	Ear pain	·	·	✓
SD	Exposure to SARS-CoV-2	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Medical observation	·	·	✓
SD	Muscle spasms	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Office visit	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	·	·	✓
SD	SARS-CoV-2 test	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinus congestion	·	·	✓
SRO	Injection site urticaria	·	·	✓

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