YXW-45234-35375

5 vaccinations 9 coded responses 44 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 919 / CA
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Survey response — day 0, dose 1
MedDRA: Movement disorder, Pain in extremity — Feeling: Good

Free text: My arm is a little sore when I raise it above my shoulder

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good

Free text: Typical soreness at injection site. Mild symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Joint pains

Free text: I got it just minutes before this check in. I am literally sitting my 15 min before I can leave.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Free text: Severe lower back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Free text: lower back pain is very bad

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 · Muscle or body aches

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

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

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

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

Adult check-in
2021-08-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Dose 3 — Moderna
2021-12-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-04
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-18
Dose 4 — Moderna
2022-04-19
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-04-20
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-04-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-25
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-02
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-09
Survey response — day 21, dose 4
MedDRA: Cough, Nasal congestion, Pain, Rhinorrhoea — Feeling: Fair

Free text: Stuffy runny nose, cough, body aches

MedDRA releases: 2024-11 · check-in free text available
2022-05-18
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-30
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-18
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-19
Dose 5 — Pfizer-BioNTech
2022-10-10
Survey response — day 21, dose 5
MedDRA: Aphonia, Cough, Lethargy, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Sinusitis — 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: Cough, fevers, Sore throat, loss of voice, congestion, runny nose, sinus infection, extreme lethargy

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Report sent to call center — day 21, dose 5
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 · 1 call case(s)
2022-10-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-17
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2022-10-25
Survey response — day 35, dose 5
MedDRA: Cough, Decreased appetite, Diarrhoea, Headache, Influenza, Lethargy, Neuralgia, Pain, Pyrexia, Sneezing — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: One week after getting Pfizer booster I coincidentally got the flu (?) with lethargy, loss of appetite, aches, neuralgia and all that goes along with flu, coughing, sneezing, diarrhea, headache, fevers. This has gone on for 6+ weeks.

MedDRA releases: 2024-11 · check-in free text available
2022-10-31
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-19
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-20
Survey response — 6 months, dose 5
MedDRA: Biopsy breast abnormal, Breast cancer, Breast conserving surgery, Invasive ductal breast carcinoma, Lymphoma, Mastectomy, Office visit — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-03-20
Report sent to call center — 6 months, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-03-21
Call 1 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-09-03	Moderna	No
4	2022-04-18	Moderna	No
5	2022-09-19	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2022-10-10	Successful 2022-10-11	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-20	Unsuccessful

Free text

Release 2 — day 0, dose 1

2021-01-14

Systemic reaction (other): My arm is a little sore when I raise it above my shoulder

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Typical soreness at injection site. Mild symptoms

Release 4 — day 0, dose 2

2021-02-11

Systemic reaction (other): I got it just minutes before this check in. I am literally sitting my 15 min before I can leave.

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Severe lower back pain

2021-02-14

Systemic reaction (other): lower back pain is very bad

Release 11 — day 21, dose 4

2022-05-09

Symptoms: Stuffy runny nose, cough, body aches

Release 12 — day 21, dose 5

2022-10-10

Symptoms: Cough, fevers, Sore throat, loss of voice, congestion, runny nose, sinus infection, extreme lethargy

Release 12 — day 35, dose 5

2022-10-25

Symptoms: One week after getting Pfizer booster I coincidentally got the flu (?) with lethargy, loss of appetite, aches, neuralgia and all that goes along with flu, coughing, sneezing, diarrhea, headache, fevers. This has gone on for 6+ weeks.

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	Biopsy breast abnormal	·	·	✓
HCVO	Breast cancer	·	·	✓
HCVO	Breast conserving surgery	·	·	✓
HCVO	Mastectomy	·	·	✓
HCVO	Office visit	·	·	✓
SD	Aphonia	·	·	✓
SD	Cough	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Headache	·	·	✓
SD	Influenza	·	·	✓
SD	Invasive ductal breast carcinoma	·	·	✓
SD	Lethargy	·	·	✓
SD	Lymphoma	·	·	✓
SD	Mastectomy	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Neuralgia	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Sinusitis	·	·	✓
SD	Sneezing	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Movement disorder	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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