Z6B-10456-36494

4 vaccinations 9 coded responses 22 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 967 / HI
Registered: 2021-04-15

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

2021-04-14
Dose 1 — Moderna
2021-04-15
Registered in v-safe
2021-04-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-16
Survey response — days 1–6 daily, dose 1
MedDRA: Menstruation irregular — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Triggered a second period.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-18
Survey response — days 1–6 daily, dose 1
MedDRA: Oral mucosal blistering — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mouth blisters 3 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Headache · Be unable to do your normal daily activities

Adult check-in
2021-04-21
Health check-in — day 7, dose 1
Feeling: Fair · Fever · None

Adult check-in
2021-05-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-05
Survey response — day 21, dose 1
MedDRA: Headache, Kidney infection, Pyrexia — Feeling: Fair · Be unable to work, 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: Constant 100 -101 temperature. Developed kidney infection, started a week after shot. Headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Report sent to call center — day 21, dose 1
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)
2021-05-14
Dose 2 — Moderna
2021-05-15
Survey response — days 1–6 daily, dose 2
MedDRA: Arthritis, Pre-existing disease — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Arthritis flare in fingers and toes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-18
Survey response — days 1–6 daily, dose 2
MedDRA: Neck pain — Feeling: Fair · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Left side of neck is tender for several days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-21
Health check-in — day 7, dose 2
Feeling: Fair · Site: Itching · Fever · None

Adult check-in
2021-05-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-20
Survey response — day 35, dose 2
MedDRA: Asthenia, Headache, Oropharyngeal pain, Pyrexia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Fever, sore throat, weakness and headache. I may have caught the flu, but rarely go out anywhere. I was around many unmasked tourists at an outdoor marketplace, with a mask, to pick up food.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-11-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-28
Dose 3 — Pfizer-BioNTech
2022-05-04
Call 1 — Left Voicemail
2022-05-11
Dose 4 — Moderna
2022-05-14
Survey response — days 1–6 daily, dose 4
MedDRA: Arthralgia, Asthenia, Chills, Mobility decreased, Pain, Pyrexia — Feeling: Fair · Joint pains, Muscle or body aches

Free text: First 24 hours after vaccination high fever, chills, body aches, joint pain and weakness. For 8 hours I was unable to get out of bed.

MedDRA releases: 2024-11 · check-in free text available
2022-05-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-17
Survey response — days 1–6 daily, dose 4
MedDRA: Muscular weakness — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Leg weakness

MedDRA releases: 2024-11 · check-in free text available
2022-06-02
Survey response — day 21, dose 4
MedDRA: Arthralgia, Arthritis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Arthritis and joint pain

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-14	Moderna
2	2021-05-14	Moderna
3	2021-12-28	Pfizer-BioNTech	No
4	2022-05-11	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-05	Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-16

Systemic reaction (other): Triggered a second period.

2021-04-18

Systemic reaction (other): Mouth blisters 3 days

Release 8 — day 21, dose 1

2021-05-05

Symptoms: Constant 100 -101 temperature. Developed kidney infection, started a week after shot. Headache

Release 8 — days 1–6 daily, dose 2

2021-05-15

Systemic reaction (other): Arthritis flare in fingers and toes

2021-05-18

Systemic reaction (other): Left side of neck is tender for several days

Release 9 — day 35, dose 2

2021-06-20

Symptoms: Fever, sore throat, weakness and headache. I may have caught the flu, but rarely go out anywhere. I was around many unmasked tourists at an outdoor marketplace, with a mask, to pick up food.

Release 11 — days 1–6 daily, dose 4

2022-05-14

Systemic reaction (other): First 24 hours after vaccination high fever, chills, body aches, joint pain and weakness. For 8 hours I was unable to get out of bed.

2022-05-17

Systemic reaction (other): Leg weakness

Release 11 — day 21, dose 4

2022-06-02

Symptoms: Arthritis and joint pain

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	Arthritis	·	·	✓
SD	Asthenia	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Kidney infection	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SRO	Arthralgia	·	·	✓
SRO	Arthritis	✓	✓	✓
SRO	Asthenia	·	·	✓
SRO	Chills	·	·	✓
SRO	Menstruation irregular	✓	✓	✓
SRO	Mobility decreased	·	·	✓
SRO	Muscular weakness	·	·	✓
SRO	Neck pain	✓	✓	✓
SRO	Oral mucosal blistering	✓	✓	✓
SRO	Pain	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pyrexia	·	·	✓

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