YUS-15715-63680

4 vaccinations 8 coded responses 38 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 973 / OR
Registered: 2021-02-12

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

2021-02-12
Registered in v-safe
2021-02-12
Dose 1 — Moderna
2021-02-24
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Moderna
2021-03-12
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fever · Joint pains, Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Free text: I am tired because Im old, 86. I cant tell if its worse because of the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Swelling, Itching

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Limb mass, Peripheral swelling — Feeling: Good · Site: Swelling

Free text: The swelling I reported above, its just a lump, a hard lump in my arm where I got the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 7, dose 2
MedDRA: Injection site pain — Feeling: Good

Free text: The shot site is still a little tender when I touch it, but my arm does not hurt.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-09-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
Co-administered: Flu
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-26
Survey response — 6 months, dose 3
MedDRA: Nasopharyngitis, Pyrexia, SARS-CoV-2 test negative — 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

Free text: Symptoms: Fever, cold symptoms · Healthcare visit (other): Doctor suggested Covid test which I had and it was negative

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-04-28
Call 1 — Could Not Reach Participant
2022-05-03
Call 2 — Left Voicemail
2022-05-17
Dose 4 — Moderna
2022-05-17
Survey response — day 0, dose 4
MedDRA: Adverse reaction — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I had these symptoms because I am 87, probably not because of the shot.

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2022-05-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-24
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-31
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-08
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-14
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-21
Survey response — day 35, dose 4
MedDRA: Productive cough — Feeling: Good

Free text: A productive cough

MedDRA releases: 2024-11 · check-in free text available
2022-06-28
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-05-17
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna
3	2021-10-26	Moderna	Flu
4	2022-05-17	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-26	Unsuccessful

Free text

Release 5 — day 0, dose 2

2021-03-12

Systemic reaction (other): No

Release 5 — days 1–6 daily, dose 2

2021-03-16

Systemic reaction (other): I am tired because Im old, 86. I cant tell if its worse because of the shot.

2021-03-17

Systemic reaction (other): No

2021-03-18

Systemic reaction (other): The swelling I reported above, its just a lump, a hard lump in my arm where I got the shot.

Release 6 — day 7, dose 2

2021-03-19

Systemic reaction (other): The shot site is still a little tender when I touch it, but my arm does not hurt.

Release 11 — 6 months, dose 3

2022-04-26

Symptoms: Fever, cold symptoms

Healthcare visit (other): Doctor suggested Covid test which I had and it was negative

Release 11 — day 0, dose 4

2022-05-17

Systemic reaction (other): I had these symptoms because I am 87, probably not because of the shot.

Release 12 — day 35, dose 4

2022-06-21

Symptoms: A productive cough

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	SARS-CoV-2 test negative	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Productive cough	·	·	✓
SD	Pyrexia	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Limb mass	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓

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