YMP-30409-21951

3 vaccinations 8 coded responses 23 check-ins 8 free-text entries 2 call cases

Sex: —
Age at first dose: 46-50
ZIP prefix: 916 / CA
Registered: 2021-02-05

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

Timeline

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

2021-02-05
Registered in v-safe
2021-02-05
Dose 1 — Moderna
2021-02-05
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · Headache

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising, Injection site rash — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Free text: I just noticed a thumbprint-size bruise and rash/petechiae at the injection site (along with the swelling)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising, Injection site haemorrhage, Injection site rash — Feeling: Good · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: bruise and petechiae or rash at the injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising, Injection site haemorrhage — Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Free text: bruise and petechiae at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — day 7, dose 1
MedDRA: Injection site bruising, Injection site haemorrhage, Injection site rash — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness

Free text: dark bruise & petechiae/rash at the injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-06
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 · Be unable to do your normal daily activities

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-03-14
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-19
Survey response — day 14, dose 2
MedDRA: Fatigue, Nausea — Feeling: Good · Be unable to do your normal daily activities

Free text: strange nausea and fatigue all week but today feels okay

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-02
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-09
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-16
Survey response — day 42, dose 2
MedDRA: Abdominal pain — Feeling: Fair · 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: abdominal pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-04
Survey response — 3 months, dose 2
MedDRA: Phlebitis, Unevaluable event — 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: Symptoms: phlebitid · Healthcare visit (other): ultrasound

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
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)
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-10-31
Dose 3 — Moderna
2021-12-15
Call 1 — Left Voicemail
2022-05-03
Survey response — 6 months, dose 3
MedDRA: COVID-19, Cough, Pleural effusion, Slipping rib syndrome — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: had COVID March/April. Still have fluid in rt lung. Displaced rib coughing and need PT

MedDRA releases: 2024-11 · check-in free text available
2022-11-02
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna
3	2021-10-31	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-16	Unsuccessful
2021-06-04	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-09

Systemic reaction (other): I just noticed a thumbprint-size bruise and rash/petechiae at the injection site (along with the swelling)

2021-02-10

Systemic reaction (other): bruise and petechiae or rash at the injection site

Release 4 — days 1–6 daily, dose 1

2021-02-11

Systemic reaction (other): bruise and petechiae at injection site

Release 4 — day 7, dose 1

2021-02-12

Systemic reaction (other): dark bruise & petechiae/rash at the injection site

Release 5 — day 14, dose 2

2021-03-19

Symptoms: strange nausea and fatigue all week but today feels okay

Release 7 — day 42, dose 2

2021-04-16

Symptoms: abdominal pain

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: phlebitid

Healthcare visit (other): ultrasound

Release 11 — 6 months, dose 3

2022-05-03

Symptoms: had COVID March/April. Still have fluid in rt lung. Displaced rib coughing and need PT

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	Unevaluable event	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Phlebitis	✓	✓	✓
SD	Pleural effusion	·	·	✓
SD	Slipping rib syndrome	·	·	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site haemorrhage	✓	✓	✓
SRO	Injection site rash	✓	✓	✓

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