YXK-27273-90007

3 vaccinations 6 coded responses 35 check-ins 6 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 331 / FL
Registered: 2021-02-12

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Registered dependents

C9C-33600-39676 Child or adolescent in my care · Female · 2021-06-22

MC3-28363-01979 Child or adolescent in my care · Female · 2021-06-22

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
2021-02-12
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

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

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
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
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
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
2021-04-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Dose 3 — Moderna
2021-08-21
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Musculoskeletal chest pain, Neck pain, Pain in extremity — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Feeling of achiness in the arm down to the hand where I got the injection also by the ribcage and side of armpit area and up into neck

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-22
Survey response — days 1–6 daily, dose 3
MedDRA: Burning sensation, Chest pain, Discomfort — Feeling: Good · Site: Pain · Headache, Joint pains

Free text: Weird burning sensation over front and back of shoulder and across chest on side of vaccine. Also in both knees. It moves around my body. A feeling of burning and heaviness.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Survey response — day 7, dose 3
MedDRA: Chest pain, Dizziness, Emergency care, Nausea, Office visit — Feeling: Fair · Site: Pain · Nausea · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Chest pain. Nausea. Dizzy. Went to urgent care then ER to check out my heart Bc I was scared of myocarditis. EKG end blood work were normal and they sent me home.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-30
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-08-30
Call successful
Does not wish to fill out VAERS report
2021-09-06
Survey response — day 21, dose 3
MedDRA: Burning sensation, Coordination abnormal, Hypoaesthesia — Feeling: Fair

Free text: Burning in hands and lower legs and feet and some numbness too. Dizzy. Feel uncoordinated.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-13
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-09-20
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-09-27
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-11-15
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-14
Survey response — 6 months, dose 3
MedDRA: Pudendal canal syndrome — 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, Outpatient clinic or urgent care clinic visit

Free text: Pudendal neuralgia

MedDRA releases: 2024-11 · check-in free text available
2022-02-14
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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-15
Call successful
Does not wish to fill out VAERS report
2022-08-16
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna
3	2021-08-16	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-08-23	Successful 2021-08-30	Does not wish to fill out VAERS report
2022-02-14	Successful 2022-02-15	Does not wish to fill out VAERS report

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-14

Systemic reaction (other): Dizzy

Release 9 — days 1–6 daily, dose 3

2021-08-21

Systemic reaction (other): Feeling of achiness in the arm down to the hand where I got the injection also by the ribcage and side of armpit area and up into neck

2021-08-22

Systemic reaction (other): Weird burning sensation over front and back of shoulder and across chest on side of vaccine. Also in both knees. It moves around my body. A feeling of burning and heaviness.

Release 9 — day 7, dose 3

2021-08-23

Systemic reaction (other): Chest pain. Nausea. Dizzy. Went to urgent care then ER to check out my heart Bc I was scared of myocarditis. EKG end blood work were normal and they sent me home.

Release 9 — day 21, dose 3

2021-09-06

Symptoms: Burning in hands and lower legs and feet and some numbness too. Dizzy. Feel uncoordinated.

Release 11 — 6 months, dose 3

2022-02-14

Symptoms: Pudendal neuralgia

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	Burning sensation	✓	·	✓
SD	Coordination abnormal	✓	·	✓
SD	Hypoaesthesia	✓	·	✓
SD	Pudendal canal syndrome	·	·	✓
SRO	Axillary pain	✓	·	✓
SRO	Burning sensation	✓	·	✓
SRO	Chest pain	✓	·	✓
SRO	Discomfort	✓	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Emergency care	✓	·	✓
SRO	Musculoskeletal chest pain	✓	·	✓
SRO	Nausea	✓	·	✓
SRO	Neck pain	✓	·	✓
SRO	Office visit	✓	·	✓
SRO	Pain in extremity	✓	·	✓

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