YS6-18740-80891

4 vaccinations 4 coded responses 37 check-ins 4 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 304 / GA
Registered: 2021-02-22

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

2021-02-15
Dose 1 — Moderna
2021-02-22
Registered in v-safe
2021-02-22
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Joint pains · Be unable to do your normal daily activities

Adult check-in
2021-03-01
Survey response — day 14, dose 1
MedDRA: Injected limb mobility decreased, Injection site erythema, Injection site nodule, Injection site pruritus, Injection site rash, Office visit, Pain in extremity — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: My left arm was initially sore, hard to lift like weighted. I had a big knot at injection site that lasted for about 2 weeks with major itching, a reddish- pink circle, and little hard black pimples that brushed off. My NP wants it ment. at 2nd one · Healthcare visit (other): Nurse practitioner visit at insulin infusion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-08
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-16
Dose 2 — Moderna
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Chills, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Joint pains

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-23
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-03-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-27
Survey response — day 42, dose 2
MedDRA: Blepharospasm, Blood pressure increased — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: TWITCHING OF LEFT EYE, UNSTABLE BP- TRENDING HIGH, VERY HIGH, RENAL FUNCTION DECREASE

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-19
Survey response — 6 months, dose 2
MedDRA: Arthropathy, Back disorder, Office visit, Renal impairment — Feeling: Good · 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: I have experienced decreased renal function and additional issues with my back and joints. · Healthcare visit (other): Renal specialists / pain mgmt. visits in and out of town

MedDRA releases: 2024-11 · check-in free text available
2021-09-19
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

1 call case(s)
2021-09-20
Call 1 — Left Voicemail
2021-10-29
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site induration — Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Free text: Hardness at injection site

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · None

Adult check-in
2021-11-08
Health check-in — day 7, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-20
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-03
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-10
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-28
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-12
Dose 4 — Moderna
2022-04-19
Health check-in — day 7, dose 4
Feeling: Good · Site: Pain, Swelling · Joint pains, Fatigue or tiredness

Adult check-in
2022-04-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-05
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-12
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-11
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-12
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-15	Moderna
2	2021-03-16	Moderna
3	2021-10-29	Moderna	No
4	2022-04-12	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-01	Unsuccessful
2021-04-27	Unsuccessful
2021-09-19	Unsuccessful

Free text

Release 4 — day 14, dose 1

2021-03-01

Symptoms: My left arm was initially sore, hard to lift like weighted. I had a big knot at injection site that lasted for about 2 weeks with major itching, a reddish- pink circle, and little hard black pimples that brushed off. My NP wants it ment. at 2nd one cut off by CDC

Healthcare visit (other): Nurse practitioner visit at insulin infusion

Release 8 — day 42, dose 2

2021-04-27

Symptoms: TWITCHING OF LEFT EYE, UNSTABLE BP- TRENDING HIGH, VERY HIGH, RENAL FUNCTION DECREASE

Release 9 — 6 months, dose 2

2021-09-19

Symptoms: I have experienced decreased renal function and additional issues with my back and joints.

Healthcare visit (other): Renal specialists / pain mgmt. visits in and out of town

Release 10 — days 1–6 daily, dose 3

2021-11-01

Systemic reaction (other): Hardness at injection site

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	Arthropathy	·	·	✓
SD	Back disorder	·	·	✓
SD	Blepharospasm	✓	✓	✓
SD	Blood pressure increased	✓	✓	✓
SD	Injected limb mobility decreased	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site nodule	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Renal impairment	·	·	✓
SRO	Injection site induration	·	·	✓

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