YPH-52147-62362

5 vaccinations 8 coded responses 35 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 481 / MI
Registered: 2021-01-18

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

2021-01-18
Registered in v-safe
2021-01-18
Dose 1 — Moderna
2021-01-18
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Muscle or body aches, Diarrhea

Adult check-in
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good · Headache, Diarrhea

Free text: Feeling itchy all over my body

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good · Fatigue or tiredness

Free text: Itchy feeling on my trunk area stomach shoulders

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-25
Health check-in — day 7, dose 1
Feeling: Good · Headache, Muscle or body aches

Adult check-in
2021-02-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-08
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good · Chills, Headache

Free text: Overall I feel better after this shot than the first.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Survey response — day 21, dose 2
MedDRA: Discomfort, Pruritus — Feeling: Good

Free text: My skin feels itchy ! Right hand and toes Im retired soi didnt miss work but it was uncomfortable during the day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — day 28, dose 2
MedDRA: Pruritus, Self-medication — Feeling: Good

Free text: Just seem to have mild itching taking a antihistamine seems to control it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-03
Dose 3 — Moderna
2022-02-13
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Bone pain, Self-medication — Feeling: Fair

Free text: Aching bones out of the blue my forearm would ache terribly for a day then go away. No injuries to it just aches! Later one of my shoulders would ache terribly again for no reason for a day then go away. Pain level was moderate. Had to take ibuprofen

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Dose 4 — Moderna
2022-04-28
Survey response — day 14, dose 4
MedDRA: Bone pain, Fatigue, Lethargy — Feeling: Good

Free text: After my last booster I was lethargic and my bones in my arms would just start severely aching for hours.for no apparent reason other than I received the booster shot

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-12
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-26
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-15
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-09-26
Dose 5 — Moderna
2022-09-27
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-09-28
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-09-29
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2022-10-02
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches

Adult check-in
2022-10-11
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-11-02
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2022-12-26
Survey response — 3 months, dose 5
MedDRA: Death, Pneumonia — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: My mother (b)(6)(94) received Covid vaccination the same time as I and in 1 week contracted pneumonia and died . We had no exposure to anything except receiving the latest vaccine for Covid. I'm done with vaccines and surveys. · Healthcare visit (other): My mother died from it

MedDRA releases: 2024-11 · check-in free text available
2022-12-26
Report sent to call center — 3 months, dose 5
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-12-28
Call successful
Not applicable - Accidental Reporting
2023-03-29
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-18	Moderna
2	2021-02-11	Moderna
3	2021-11-03	Moderna	No
4	2022-04-14	Moderna	No
5	2022-09-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-12-26	Successful 2022-12-28	Not applicable - Accidental Reporting

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-21

Systemic reaction (other): Feeling itchy all over my body

2021-01-22

Systemic reaction (other): Itchy feeling on my trunk area stomach shoulders

Release 4 — days 1–6 daily, dose 2

2021-02-15

Systemic reaction (other): Overall I feel better after this shot than the first.

Release 5 — day 21, dose 2

2021-03-04

Symptoms: My skin feels itchy ! Right hand and toes Im retired soi didnt miss work but it was uncomfortable during the day

Release 5 — day 28, dose 2

2021-03-11

Symptoms: Just seem to have mild itching taking a antihistamine seems to control it.

Release 11 — 12 months, dose 2

2022-02-13

Symptoms: Aching bones out of the blue my forearm would ache terribly for a day then go away. No injuries to it just aches! Later one of my shoulders would ache terribly again for no reason for a day then go away. Pain level was moderate. Had to take ibuprofen cut off by CDC

Release 11 — day 14, dose 4

2022-04-28

Symptoms: After my last booster I was lethargic and my bones in my arms would just start severely aching for hours.for no apparent reason other than I received the booster shot

Release 12 — 3 months, dose 5

2022-12-26

Symptoms: My mother (b)(6)(94) received Covid vaccination the same time as I and in 1 week contracted pneumonia and died . We had no exposure to anything except receiving the latest vaccine for Covid. I'm done with vaccines and surveys.

Healthcare visit (other): My mother died from it

redacted (b)(6)

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	Death	·	·	✓
SD	Arthralgia	·	·	✓
SD	Bone pain	·	·	✓
SD	Death	·	·	✓
SD	Discomfort	✓	·	✓
SD	Fatigue	·	·	✓
SD	Lethargy	·	·	✓
SD	Pneumonia	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Self-medication	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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