YS5-24720-25233

2 vaccinations 10 coded responses 23 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 550 / MN
Registered: 2021-09-16

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

2021-09-16
Registered in v-safe
2021-09-16
Dose 1 — Moderna
2021-09-16
Survey response — day 0, dose 1
MedDRA: Dysphonia, Immediate post-injection reaction, Lip swelling, Pre-existing disease, Self-medication — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: I have mast cell activation syndrome. Within the first 30 min i experienced swelling of lips and hoarse voice. Resolved within 30 min of Benadryl.

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-09-19
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-09-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-23
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-30
Survey response — day 14, dose 1
MedDRA: Abdominal pain, Pelvic pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Abdominal and pelvic pain. Not sure if related to the vaccine.

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
Survey response — day 21, dose 1
MedDRA: Abdominal pain, Arthralgia, Pelvic pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: More joint, abdominal, pelvic pain

MedDRA releases: 2024-11 · check-in free text available
2021-10-14
Dose 2 — Moderna
2021-10-14
Survey response — day 0, dose 2
MedDRA: Anaphylactoid reaction, Dysphonia, Eye swelling, Lip swelling, Nausea, Pre-existing disease — Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Free text: I have MCAS. 1.5 hours after shot I had typical anaphylaxis symptoms: swelling around eyes, lip swelling, nausea, hoarse voice.

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Survey response — days 1–6 daily, dose 2
MedDRA: Epistaxis, Pain of skin — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Nosebleed & skin hurts all over

MedDRA releases: 2024-11 · check-in free text available
2021-10-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-17
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling hot — Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Still feels hot.

MedDRA releases: 2024-11 · check-in free text available
2021-10-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-21
Health check-in — day 7, dose 2
Feeling: Fair · Site: Redness, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-10-28
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-11-11
Survey response — day 28, dose 2
MedDRA: Gingival bleeding, Toothache — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tooth pain & bleeding gums

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-11-25
Survey response — day 42, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-01-15
Survey response — 3 months, dose 2
MedDRA: Pain in extremity — Feeling: Fair

Free text: Persistent right calf pain.

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Survey response — 6 months, dose 2
MedDRA: Fungal infection, Headache, Mast cell activation syndrome, Myalgia — 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, Outpatient clinic or urgent care clinic visit

Free text: Headaches, muscle aches, increased frequency of mast cell reactions, recurrent yeast infection

MedDRA releases: 2024-11 · check-in free text available
2022-04-14
Report sent to call center — 6 months, dose 2
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 · 1 call case(s)
2022-04-18
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-09-16	Moderna	No
2	2021-10-14	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-14	Unsuccessful

Free text

Release 9 — day 0, dose 1

2021-09-16

Systemic reaction (other): I have mast cell activation syndrome. Within the first 30 min i experienced swelling of lips and hoarse voice. Resolved within 30 min of Benadryl.

Release 9 — day 14, dose 1

2021-09-30

Symptoms: Abdominal and pelvic pain. Not sure if related to the vaccine.

Release 10 — day 21, dose 1

2021-10-07

Symptoms: More joint, abdominal, pelvic pain

Release 10 — day 0, dose 2

2021-10-14

Systemic reaction (other): I have MCAS. 1.5 hours after shot I had typical anaphylaxis symptoms: swelling around eyes, lip swelling, nausea, hoarse voice.

Release 10 — days 1–6 daily, dose 2

2021-10-15

Systemic reaction (other): Nosebleed & skin hurts all over

2021-10-17

Systemic reaction (other): Still feels hot.

Release 10 — day 28, dose 2

2021-11-11

Symptoms: Tooth pain & bleeding gums

Release 10 — day 42, dose 2

2021-11-25

Symptoms: Fatigue

Release 10 — 3 months, dose 2

2022-01-15

Symptoms: Persistent right calf pain.

Release 11 — 6 months, dose 2

2022-04-14

Symptoms: Headaches, muscle aches, increased frequency of mast cell reactions, recurrent yeast infection

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
SD	Abdominal pain	·	·	✓
SD	Arthralgia	·	·	✓
SD	Fatigue	·	·	✓
SD	Fungal infection	·	·	✓
SD	Gingival bleeding	·	·	✓
SD	Headache	·	·	✓
SD	Mast cell activation syndrome	·	·	✓
SD	Myalgia	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pelvic pain	·	·	✓
SD	Toothache	·	·	✓
SRO	Anaphylactoid reaction	·	·	✓
SRO	Dysphonia	·	·	✓
SRO	Epistaxis	·	·	✓
SRO	Eye swelling	·	·	✓
SRO	Feeling hot	·	·	✓
SRO	Immediate post-injection reaction	·	·	✓
SRO	Lip swelling	·	·	✓
SRO	Nausea	·	·	✓
SRO	Pain of skin	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Self-medication	·	·	✓

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