YSV-25175-05195

4 vaccinations 12 coded responses 47 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 995 / AK
Registered: 2021-01-17

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

2021-01-16
Dose 1 — Moderna
2021-01-17
Registered in v-safe
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Myalgia — Feeling: Good · Site: Pain

Free text: Bruise like pain in muscle below injection site is less than yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-20
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: Still sore in upper arm but much less - mostly not noticeable.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-13
Dose 2 — Moderna
2021-02-13
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Fatigue or tiredness

Free text: Insomnia.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Itching · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Back pain, Dry mouth, Food aversion, Food refusal, Insomnia, Myalgia, Nausea, Pain, Pruritus, Taste disorder — Feeling: Poor · Site: Redness, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Insomnia, lumbar pain, general itchiness, dry mouth, pain in one quadricep radiating from hip/lumbar, nausea, taste off, food repulsion. Latter might just be from the pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Dry mouth, Nausea, Pain in extremity — Feeling: Fair · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Left side lumbar pain around hip joint. Pain in left quad muscle. No other joints or muscles affected. Pain level varies overtime. Worse midday. Pain causes nausea, dry mouth. I suspect vaccine myelitis but could be exercise overuse.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — day 7, dose 2
MedDRA: Autoimmune disorder, Back pain, Myalgia — Feeling: Poor · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Severe lumbar pain and down front of quadriceps on one side. Seriously believe it might be autoimmune response on a spinal nerve. Or could be exercise related. Very hard to tell which. Am trying to tough it out. Worried prednisone would screw up covid immunity. May need further tests to see if it is rare one-sided myelitis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Survey response — day 14, dose 2
MedDRA: Back pain, Neuralgia, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Lumbar pain with nerve pain down thigh. Could be demyelination due to autoimmune overreaction but doc refuses (?) to order blood test that would confirm or exclude. Now on oral prednisone which makes test moot. Improving gradually. · Healthcare visit (other): Regular office visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-06
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-27
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-14
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-15
Dose 3 — Moderna
2021-12-18
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue, Headache, Loss of personal independence in daily activities, Nausea, Self-medication — Feeling: Fair · Site: Pain, Redness, Itching · Fever · Headache

Free text: For first 48 hrs I limited daily activities due to had fatigue,headache,nausea. They have abated. Still mild headache treated with Advil.

MedDRA releases: 2024-11 · check-in free text available
2021-12-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Itching · None

Adult check-in
2021-12-20
Survey response — days 1–6 daily, dose 3
MedDRA: Brain fog — Feeling: Good · Site: Pain, Redness, Itching

Free text: Brain fog

MedDRA releases: 2024-11 · check-in free text available
2021-12-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Itching · None

Adult check-in
2021-12-21
Call 1 — Left Voicemail
2021-12-22
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain, Redness, Itching · None

Adult check-in
2021-12-29
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-05
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-19
Survey response — day 35, dose 3
MedDRA: Arthralgia, Nasal congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Hip is sore- also stuffy nose.

MedDRA releases: 2024-11 · check-in free text available
2022-01-26
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-16
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-25
Dose 4 — Moderna
2022-05-28
Survey response — days 1–6 daily, dose 4
MedDRA: Night sweats — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Symptoms from night sweat. Symptoms began 5/26-5/27 have abated by 5/28

MedDRA releases: 2024-11 · check-in free text available
2022-05-30
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Itching · None

Adult check-in
2022-05-31
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-06-01
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-06-08
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-15
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-22
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-29
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-06
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-24
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-25
Survey response — 12 months, dose 4
MedDRA: Bronchitis, COVID-19, Seasonal allergy — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-16	Moderna
2	2021-02-13	Moderna
3	2021-12-15	Moderna	No
4	2022-05-25	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-27	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-18

Systemic reaction (other): Bruise like pain in muscle below injection site is less than yesterday

2021-01-20

Systemic reaction (other): Still sore in upper arm but much less - mostly not noticeable.

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Insomnia.

2021-02-18

Systemic reaction (other): Insomnia, lumbar pain, general itchiness, dry mouth, pain in one quadricep radiating from hip/lumbar, nausea, taste off, food repulsion. Latter might just be from the pain

2021-02-19

Systemic reaction (other): Left side lumbar pain around hip joint. Pain in left quad muscle. No other joints or muscles affected. Pain level varies overtime. Worse midday. Pain causes nausea, dry mouth. I suspect vaccine myelitis but could be exercise overuse.

Release 4 — day 7, dose 2

2021-02-20

Systemic reaction (other): Severe lumbar pain and down front of quadriceps on one side. Seriously believe it might be autoimmune response on a spinal nerve. Or could be exercise related. Very hard to tell which. Am trying to tough it out. Worried prednisone would screw up covid immunity. May need further tests to see if it is rare one-sided myelitis.

Release 4 — day 14, dose 2

2021-02-27

Symptoms: Lumbar pain with nerve pain down thigh. Could be demyelination due to autoimmune overreaction but doc refuses (?) to order blood test that would confirm or exclude. Now on oral prednisone which makes test moot. Improving gradually.

Healthcare visit (other): Regular office visit

Release 10 — days 1–6 daily, dose 3

2021-12-18

Systemic reaction (other): For first 48 hrs I limited daily activities due to had fatigue,headache,nausea. They have abated. Still mild headache treated with Advil.

2021-12-20

Systemic reaction (other): Brain fog

Release 10 — day 35, dose 3

2022-01-19

Symptoms: Hip is sore- also stuffy nose.

Release 11 — days 1–6 daily, dose 4

2022-05-28

Systemic reaction (other): Symptoms from night sweat. Symptoms began 5/26-5/27 have abated by 5/28

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	Arthralgia	·	·	✓
SD	Back pain	✓	✓	✓
SD	Bronchitis	·	·	✓
SD	COVID-19	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Neuralgia	✓	✓	✓
SD	Seasonal allergy	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Autoimmune disorder	✓	✓	○
SRO	Back pain	✓	✓	✓
SRO	Brain fog	·	·	✓
SRO	Dry mouth	✓	✓	✓
SRO	Fatigue	·	·	✓
SRO	Food aversion	✓	·	✓
SRO	Food refusal	○	✓	○
SRO	Headache	·	·	✓
SRO	Insomnia	✓	✓	✓
SRO	Loss of personal independence in daily activities	·	·	✓
SRO	Myalgia	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Night sweats	·	·	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Self-medication	·	·	✓
SRO	Taste disorder	✓	✓	✓

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