YKW-30857-26447

4 vaccinations 7 coded responses 13 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 208 / MD
Registered: 2021-02-07

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

2021-01-04
Dose 1 — Moderna
2021-02-02
Dose 2 — Moderna
2021-02-07
Registered in v-safe
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Fair · Site: Redness, Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Fatigue has been almost constant for the past 5 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Injection site erythema, Injection site pruritus, Pruritus — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Itching (and redness) about 2 distal from injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — day 7, dose 2
Feeling: Fair · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-09-20
Dose 3 — Moderna
2021-10-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-01
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-20
Survey response — 3 months, dose 3
MedDRA: Back injury, Bronchiectasis, Mycobacterium avium complex infection, Physiotherapy — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Bronchiectasis and MAC diagnosed over the past year. Also threw my back out, physical therapy over past few weeks. · Healthcare visit (other): Physical therapy

MedDRA releases: 2024-11 · check-in free text available
2021-12-20
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-22
Call successful
Not applicable - Accidental Reporting
2022-03-21
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-04
Dose 4 — Moderna
2022-04-14
Survey response — day 7, dose 4
MedDRA: Back pain, Physiotherapy — Feeling: Poor · Muscle or body aches · 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): Have avoided taking Advil r/t recent vaccination. Have back pain, hesitant to take NSAIDs · Healthcare visit (other): Physical therapy

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Report sent to call center — day 7, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-18
Survey response — day 14, dose 4
MedDRA: Dizziness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Extreme dizziness for three days, starting about 9 days after vaccination

MedDRA releases: 2024-11 · check-in free text available
2022-04-19
Call 1 — Left Voicemail
2022-05-02
Survey response — day 28, dose 4
MedDRA: Bronchiectasis, Night sweats — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Night sweats, likely related to bronchiectasis.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-03
Call 1 — Requested Callback
2022-05-04
Callback requested for
12:00PM ET
2022-05-04
Call successful
Does not wish to fill out VAERS report
2022-05-18
Survey response — day 42, dose 4
MedDRA: Back pain, Massage — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Continuing back pain · Healthcare visit (other): Rx for muscle relaxant, massage

MedDRA releases: 2024-11 · check-in free text available
2022-05-18
Report sent to call center — day 42, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-19
Call successful
Not applicable - Accidental Reporting
2022-07-04
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-02	Moderna
3	2021-09-20	Moderna	No
4	2022-04-04	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-20	Successful 2021-12-22	Not applicable - Accidental Reporting
2022-04-14	Successful	Does not wish to fill out VAERS report
2022-05-02	Successful 2022-05-04	Does not wish to fill out VAERS report
2022-05-18	Successful 2022-05-19	Not applicable - Accidental Reporting

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): Fatigue has been almost constant for the past 5 days.

2021-02-08

Systemic reaction (other): Itching (and redness) about 2 distal from injection site

Release 10 — 3 months, dose 3

2021-12-20

Symptoms: Bronchiectasis and MAC diagnosed over the past year. Also threw my back out, physical therapy over past few weeks.

Healthcare visit (other): Physical therapy

Release 11 — day 7, dose 4

2022-04-14

Systemic reaction (other): Have avoided taking Advil r/t recent vaccination. Have back pain, hesitant to take NSAIDs

Healthcare visit (other): Physical therapy

Release 11 — day 14, dose 4

2022-04-18

Symptoms: Extreme dizziness for three days, starting about 9 days after vaccination

Release 11 — day 28, dose 4

2022-05-02

Symptoms: Night sweats, likely related to bronchiectasis.

Release 11 — day 42, dose 4

2022-05-18

Symptoms: Continuing back pain

Healthcare visit (other): Rx for muscle relaxant, massage

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	Massage	·	·	✓
HCVO	Physiotherapy	·	·	✓
SD	Back injury	·	·	✓
SD	Back pain	·	·	✓
SD	Bronchiectasis	·	·	✓
SD	Dizziness	·	·	✓
SD	Mycobacterium avium complex infection	·	·	✓
SD	Night sweats	·	·	✓
SD	Physiotherapy	·	·	✓
SRO	Back pain	·	·	✓
SRO	Erythema	○	✓	○
SRO	Fatigue	✓	✓	✓
SRO	Injection site erythema	✓	·	✓
SRO	Injection site pruritus	✓	·	✓
SRO	Pruritus	○	✓	○

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