YX4-27761-00553

2 vaccinations 7 coded responses 16 check-ins 7 free-text entries 4 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 064 / CT
Registered: 2021-03-04

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

2021-03-02
Dose 1 — Moderna
2021-03-04
Registered in v-safe
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Feeling abnormal, Feeling hot, Myalgia, Nausea, Pain, Vomiting — Feeling: Good

Free text: I missed reporting any symptoms the day after I received the shot. I felt a bit foggy and feverish but didnt have a temperature. I also felt nauseous and at one point thought I was going to pass out. I had muscle soreness and felt achy. Had alittle dinner but later vomited. Since that day (which was 3/3... day after my first vaccine, I have not had any symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Myalgia, Pain — Feeling: Good · Muscle or body aches

Free text: Do not believe muscle /body aches are related to vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — day 7, dose 1
MedDRA: Adverse reaction — Feeling: Good · Muscle or body aches

Free text: Dont think related to vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Survey response — day 21, dose 1
MedDRA: Back pain, Medical counselling — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Back pain... unrelated to vaccine · Healthcare visit (other): Spoke to doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-30
Dose 2 — Moderna
2021-04-06
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Poor · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Unrelated to vaccine · Healthcare visit (other): Unrelated to vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Report sent to call center — day 7, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-13
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-20
Health check-in — day 21, dose 2
Feeling: Poor

Adult check-in
2021-04-27
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-06
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-13
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-29
Survey response — 3 months, dose 2
MedDRA: Back pain, Neck pain, Peripheral swelling — Feeling: Poor · Be unable to work or attend school, 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: Swollen hands and feet, neck and back pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-29
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-02
Call 1 — Could Not Reach Participant
2021-09-28
Survey response — 6 months, dose 2
MedDRA: Pneumonia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Had pneumonia

MedDRA releases: 2024-11 · check-in free text available
2021-09-28
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2021-09-29
Call 1 — Left Voicemail
2021-10-01
Call successful
Does not wish to fill out VAERS report
2022-03-30
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-02	Moderna
2	2021-03-30	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-25	Successful	Does not wish to fill out VAERS report
2021-04-06	Successful	Does not wish to fill out VAERS report
2021-06-29	Successful	Does not wish to fill out VAERS report
2021-09-28	Successful 2021-10-01	Does not wish to fill out VAERS report

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-06

Systemic reaction (other): I missed reporting any symptoms the day after I received the shot. I felt a bit foggy and feverish but didnt have a temperature. I also felt nauseous and at one point thought I was going to pass out. I had muscle soreness and felt achy. Had alittle dinner but later vomited. Since that day (which was 3/3... day after my first vaccine, I have not had any symptoms.

2021-03-08

Systemic reaction (other): Do not believe muscle /body aches are related to vaccine

Release 5 — day 7, dose 1

2021-03-09

Systemic reaction (other): Dont think related to vaccine

Release 6 — day 21, dose 1

2021-03-25

Symptoms: Back pain... unrelated to vaccine

Healthcare visit (other): Spoke to doctor

Release 7 — day 7, dose 2

2021-04-06

Systemic reaction (other): Unrelated to vaccine

Healthcare visit (other): Unrelated to vaccine

Release 9 — 3 months, dose 2

2021-06-29

Symptoms: Swollen hands and feet, neck and back pain.

Release 9 — 6 months, dose 2

2021-09-28

Symptoms: Had pneumonia

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	Medical counselling	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pneumonia	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓
SRO	Vomiting	✓	✓	✓

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