Z5D-17286-48605

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

Sex: Female
Age at first dose: 31-35
ZIP prefix: 212 / MD
Registered: 2020-12-29

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

2020-12-29
Registered in v-safe
2020-12-29
Dose 1 — Moderna
2020-12-29
Health check-in — day 0, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2020-12-30
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2020-12-31
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching

Free text: Mild sore throat

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

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-26
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-01-27
Dose 2 — Moderna
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work

Free text: Left supraclavicular lymphadenopathy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Free text: Swollen lymph nodes (Left Supraclavicular lymphadenopathy)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Swollen lymph nodes (left supraclavicular lymphadenopathy)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Mild supraclavicular lymphadenopathy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-03
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-03
Survey response — day 35, dose 2
MedDRA: Arthralgia, Back pain — Feeling: Fair

Free text: Bilateral shoulder joint pain, upper back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — day 42, dose 2
MedDRA: Arthralgia, Fatigue, Headache, Malaise, Sleep disorder — Feeling: Fair

Free text: Malaise, fatigue, headache and bilateral joint pain occurred 2wks ago. Malaise, fatigue, headache lasted 2 days. Joint pain is still occurring. It is mild but painful enough that it wakes me up in the middle of the night.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-26
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fever · Fatigue or tiredness, Nausea

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
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: Good · None

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

Adult check-in
2021-11-17
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
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-27
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-10-28
Survey response — 12 months, dose 3
MedDRA: Respiratory syncytial virus infection, Sinusitis — Feeling: Good · 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

Free text: I had RSV and a secondary bacterial sinus infection 2 weeks ago

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Report sent to call center — 12 months, dose 3
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 · 1 call case(s)
2022-11-01
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-27	Moderna
3	2021-10-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-10-28	Successful 2022-11-01	Not applicable - Accidental Reporting

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-31

Systemic reaction (other): Mild sore throat

Release 2 — days 1–6 daily, dose 2

2021-01-28

Systemic reaction (other): Left supraclavicular lymphadenopathy

Release 3 — days 1–6 daily, dose 2

2021-01-29

Systemic reaction (other): Swollen lymph nodes (Left Supraclavicular lymphadenopathy)

2021-01-30

Systemic reaction (other): Swollen lymph nodes (left supraclavicular lymphadenopathy)

2021-01-31

Systemic reaction (other): Mild supraclavicular lymphadenopathy

Release 5 — day 35, dose 2

2021-03-03

Symptoms: Bilateral shoulder joint pain, upper back pain

Release 5 — day 42, dose 2

2021-03-10

Symptoms: Malaise, fatigue, headache and bilateral joint pain occurred 2wks ago. Malaise, fatigue, headache lasted 2 days. Joint pain is still occurring. It is mild but painful enough that it wakes me up in the middle of the night.

Release 12 — 12 months, dose 3

2022-10-28

Symptoms: I had RSV and a secondary bacterial sinus infection 2 weeks ago

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	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Respiratory syncytial virus infection	·	·	✓
SD	Sinusitis	·	·	✓
SD	Sleep disorder	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓

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