YPL-29627-18431

3 vaccinations 7 coded responses 39 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 325 / FL
Registered: 2021-03-29

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

2021-03-29
Registered in v-safe
2021-04-02
Dose 1 — Moderna
2021-04-02
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Dysgeusia, Pain in extremity — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: Odd metallic taste in my mouth and arm feels like its filled with lead! Very sore (but manageable)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain, Self-medication — Feeling: Good · Site: Pain

Free text: Shot Arm still a bit sore but manageable with Tylenol/Advil. This afternoon was almost gone

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-30
Dose 2 — Moderna
2021-04-30
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-05-01
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Good · Site: Pain · Headache, Joint pains · Be unable to do your normal daily activities

Free text: Tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache

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

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-07
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-14
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-01
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Dose 3 — Moderna
2021-08-16
Survey response — day 0, dose 3
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: Arm sore from shot

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-17
Survey response — days 1–6 daily, dose 3
MedDRA: Night sweats — Feeling: Fair · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Night sweats with above only. No fever

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-08-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-08-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-08-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-08-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-08-23
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-08-30
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-09-06
Survey response — day 21, dose 3
MedDRA: Mastectomy, Neoplasm malignant — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Cancer diagnosis · Healthcare visit (other): Double mastectomy

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-06
Report sent to call center — day 21, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-09-10
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-13
Survey response — day 28, dose 3
MedDRA: Hospitalisation, Mastectomy, Sepsis, Simple mastectomy, Staphylococcal infection — 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 · Emergency room or emergency department visit, Hospitalization

Free text: (NON COVID/COVID VACCIN RELATED) Hospitalized Sep 7, 2021 because of infection = Sepsis & MERSA due to a total bilateral Mastectomy surgery Aug 31, 2021

MedDRA releases: 2024-11 · check-in free text available
2021-09-13
Report sent to call center — day 28, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-09-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-20
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-09-27
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-11-21
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-14
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-02	Moderna
2	2021-04-30	Moderna
3	2021-08-16	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-06	Successful 2021-09-10	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-13	Successful 2021-09-14	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 6 — days 1–6 daily, dose 1

2021-04-03

Systemic reaction (other): Odd metallic taste in my mouth and arm feels like its filled with lead! Very sore (but manageable)

2021-04-04

Systemic reaction (other): Shot Arm still a bit sore but manageable with Tylenol/Advil. This afternoon was almost gone

Release 8 — days 1–6 daily, dose 2

2021-05-01

Systemic reaction (other): Tired

Release 9 — day 0, dose 3

2021-08-16

Systemic reaction (other): Arm sore from shot

Release 9 — days 1–6 daily, dose 3

2021-08-17

Systemic reaction (other): Night sweats with above only. No fever

Release 9 — day 21, dose 3

2021-09-06

Symptoms: Cancer diagnosis

Healthcare visit (other): Double mastectomy

Release 9 — day 28, dose 3

2021-09-13

Symptoms: (NON COVID/COVID VACCIN RELATED) Hospitalized Sep 7, 2021 because of infection = Sepsis & MERSA due to a total bilateral Mastectomy surgery Aug 31, 2021

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	Mastectomy	✓	·	✓
SD	Hospitalisation	·	·	✓
SD	Mastectomy	·	·	✓
SD	Neoplasm malignant	✓	·	✓
SD	Sepsis	·	·	✓
SD	Simple mastectomy	·	·	✓
SD	Staphylococcal infection	·	·	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Night sweats	✓	·	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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