YS6-20919-65875

4 vaccinations 9 coded responses 21 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 330 / FL
Registered: 2021-11-12

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-02-10
Dose 1 — Moderna
2021-03-10
Dose 2 — Moderna
2021-11-12
Registered in v-safe
2021-11-12
Dose 3 — Moderna
2021-11-12
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-13
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Swollen and painful lymph node under arm.

MedDRA releases: 2024-11 · check-in free text available
2021-11-14
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy, Pain in extremity — Feeling: Good · Site: Pain

Free text: Very swollen and tender lymph node underneath arm. Painful to lower arm normally.

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-16
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good

Free text: Swollen and painful lymph node under arm.

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Fatigue or tiredness

Free text: Swollen & tender underarm Ã±ymph nodes.

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

Adult check-in
2021-11-19
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-04
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-11
Survey response — day 28, dose 3
MedDRA: Aphthous ulcer, Fatigue, Glossodynia, Oral pain, Urinary tract infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Painful, canker-like sores all over my tongue and mouth. General fatigue. Suspected UTI as well, but likely unrelated to vaccine.

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — day 35, dose 3
MedDRA: Aphthous ulcer, Oral pain — Feeling: Fair · 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: Numerous canker sores all over mouth and tongue. Painful to eat solid foods. Condition seems to be resolving itself.

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Report sent to call center — day 35, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-21
Call 2 — Left Voicemail
2021-12-24
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-11
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-15
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-08-03
Dose 4 — Moderna
2022-08-06
Survey response — days 1–6 daily, dose 4
MedDRA: Lymph node pain, Oral pain, Stomatitis — Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Painful mouth sores, lymph node pain (underarm)

MedDRA releases: 2024-11 · check-in free text available
2022-08-07
Survey response — days 1–6 daily, dose 4
MedDRA: Blister, Lymphadenopathy — Feeling: Fair · Site: Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swollen underarm lymph node, painful oral blisters

MedDRA releases: 2024-11 · check-in free text available
2022-08-08
Survey response — days 1–6 daily, dose 4
MedDRA: Mouth ulceration, Oral pain — Feeling: Fair · Fatigue or tiredness · 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: Painful oral sores.

MedDRA releases: 2024-11 · check-in free text available
2022-08-08
Report sent to call center — days 1–6 daily, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-08-09
Call 1 — Left Voicemail
2022-08-09
Call 1 — Left Voicemail
2022-08-17
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-08-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-09-16
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna	No
2	2021-03-10	Moderna	No
3	2021-11-12	Moderna	No
4	2022-08-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-12-17	Unsuccessful
2022-08-08	Unsuccessful

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-13

Systemic reaction (other): Swollen and painful lymph node under arm.

2021-11-14

Systemic reaction (other): Very swollen and tender lymph node underneath arm. Painful to lower arm normally.

2021-11-16

Systemic reaction (other): Swollen and painful lymph node under arm.

2021-11-17

Systemic reaction (other): Swollen & tender underarm Ã±ymph nodes.

Release 10 — day 28, dose 3

2021-12-11

Symptoms: Painful, canker-like sores all over my tongue and mouth. General fatigue. Suspected UTI as well, but likely unrelated to vaccine.

Release 10 — day 35, dose 3

2021-12-17

Symptoms: Numerous canker sores all over mouth and tongue. Painful to eat solid foods. Condition seems to be resolving itself.

Release 12 — days 1–6 daily, dose 4

2022-08-06

Systemic reaction (other): Painful mouth sores, lymph node pain (underarm)

2022-08-07

Systemic reaction (other): Swollen underarm lymph node, painful oral blisters

2022-08-08

Systemic reaction (other): Painful oral sores.

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	Aphthous ulcer	·	·	✓
SD	Fatigue	·	·	✓
SD	Glossodynia	·	·	✓
SD	Oral pain	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Blister	·	·	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Mouth ulceration	·	·	✓
SRO	Oral pain	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Stomatitis	·	·	✓

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