YRX-40927-85338

4 vaccinations 6 coded responses 38 check-ins 6 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 088 / NJ
Registered: 2021-01-22

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-21
Dose 1 — Moderna
2021-01-22
Registered in v-safe
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Muscle or body aches

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Body temperature decreased — Feeling: Good

Free text: Just went to podiatrist and they said I had a low temp!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · Chills

Adult check-in
2021-02-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-20
Dose 2 — Moderna
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-27
Health check-in — day 7, dose 2
Feeling: Good · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-06
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-13
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-20
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-03
Survey response — day 42, dose 2
MedDRA: Rash, Rash erythematous, Rash pruritic — Feeling: Fair

Free text: I noticed I keep getting these itchy flair up which is very red and appears on my chest which tend to last for a several hours and suddenly disappears.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-22
Dose 3 — Moderna
2021-10-24
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-29
Health check-in — day 7, dose 3
Feeling: Fair · Site: Itching · Fatigue or tiredness

Adult check-in
2021-11-05
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-12
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-21
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-24
Survey response — 6 months, dose 3
MedDRA: COVID-19, Office visit — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Corvid · Healthcare visit (other): In person PCP visit

MedDRA releases: 2024-11 · check-in free text available
2022-04-24
Report sent to call center — 6 months, 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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-26
Call successful
Not applicable - Accidental Reporting
2022-09-24
Dose 4 — Moderna
2022-10-09
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-10-15
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-24
Survey response — day 28, dose 4
MedDRA: Unevaluable event — Feeling: Fair

Free text: I think its a Reaction to a new med?

MedDRA releases: 2024-11 · check-in free text available
2022-10-30
Survey response — day 35, dose 4
MedDRA: Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Had flu vaccination and I have spent most of the past few days have been in the bed in pain and I was already still recovering from last booster I had a few weeks ago.

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-12-24
Health check-in — 3 months, dose 4
Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional

Free text: Symptoms: Flu like symptoms · Healthcare visit (other): PCP

Adult check-in · check-in free text available
2022-12-24
Call case (no matching report) — Successful
Participant prefers to complete VAERS report online
2022-12-28
Call 1 — Left Voicemail
2022-12-28
Call successful
Participant prefers to complete VAERS report online
2023-03-25
Survey response — 6 months, dose 4
MedDRA: Injection site pain, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-20	Moderna
3	2021-10-22	Moderna	No
4	2022-09-24	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-24	Successful 2022-04-26	Not applicable - Accidental Reporting
2022-12-24	Successful 2022-12-28	Participant prefers to complete VAERS report online

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Just went to podiatrist and they said I had a low temp!

Release 6 — day 42, dose 2

2021-04-03

Symptoms: I noticed I keep getting these itchy flair up which is very red and appears on my chest which tend to last for a several hours and suddenly disappears.

Release 11 — 6 months, dose 3

2022-04-24

Symptoms: Corvid

Healthcare visit (other): In person PCP visit

Release 12 — day 28, dose 4

2022-10-24

Symptoms: I think its a Reaction to a new med?

Release 12 — day 35, dose 4

2022-10-30

Symptoms: Had flu vaccination and I have spent most of the past few days have been in the bed in pain and I was already still recovering from last booster I had a few weeks ago.

Release 12 — 3 months, dose 4

2022-12-24

Symptoms: Flu like symptoms

Healthcare visit (other): PCP

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	Office visit	·	·	✓
SD	COVID-19	·	·	✓
SD	Injection site pain	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Rash	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	Unevaluable event	·	·	✓
SRO	Body temperature decreased	✓	✓	✓

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