ZBW-26791-15052

3 vaccinations 9 coded responses 34 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 058 / VT
Registered: 2021-03-20

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

QH9-26628-33695 Child or adolescent in my care · Male · 2021-11-15

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-19
Dose 1 — Moderna
2021-03-20
Registered in v-safe
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-03-26
Health check-in — day 7, dose 1
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-04-02
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-10
Survey response — day 21, dose 1
MedDRA: Breast tenderness — Feeling: Fair

Free text: No idea if its related to the vaccine but Ive been having a lot of breast tenderness on both sides. Not sure if its hormonally related but I will be talking to my gynecologist next week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Dose 2 — Moderna
2021-04-16
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site warmth — Feeling: Good · Site: Pain, Itching · Joint pains

Free text: Arm has been hot near the injection site the last few days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Joint pains, Fatigue or tiredness

Adult check-in
2021-04-22
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Tremor — Feeling: Fair · Site: Itching · Chills, Nausea

Free text: Light headed and shaky in the AM

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-04-30
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-15
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-13
Dose 3 — Moderna
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-16
Survey response — days 1–6 daily, dose 3
MedDRA: Pollakiuria — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: First few days- frequent urination

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Survey response — days 1–6 daily, dose 3
MedDRA: Breast tenderness, Tenderness — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Have been having arm pit and breast tenderness on the injection side side day after shot

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Chills, Fatigue or tiredness

Adult check-in
2021-11-21
Health check-in — day 7, dose 3
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-28
Survey response — day 14, dose 3
MedDRA: Diarrhoea, Nausea, Vomiting — Feeling: Good · Be unable to do your normal daily activities

Free text: Nausea, diarrhea and vomiting- lasted a few days. No idea if it is separate from vaccine.

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Survey response — day 21, dose 3
MedDRA: Abdominal discomfort, Diarrhoea, Gastrointestinal disorder — Feeling: Fair

Free text: Stomach issues persist. Upset stomach and diarrhea on and off.

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-31
Survey response — day 42, dose 3
MedDRA: Cough, Fatigue, Nasal congestion, Oropharyngeal pain, Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Stuffy nose sore throat body aches fatigue coughing

MedDRA releases: 2024-11 · check-in free text available
2022-02-14
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-16
Survey response — 6 months, dose 3
MedDRA: COVID-19, Dyspnoea, Fatigue, Gastrointestinal disorder, Tachycardia, Tinnitus — Feeling: Fair · 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: Shortness of breath, tachycardia, fatigue, stomach issues, ringing ears. This has all been since I had Covid at the end of December. I believe this is related to getting Covid and not the vaccination

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Report sent to call center — 6 months, dose 3
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)
2022-05-17
Call 1 — Left Voicemail
2022-11-13
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-19	Moderna
2	2021-04-16	Moderna
3	2021-11-13	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-16	Unsuccessful

Free text

Release 7 — day 21, dose 1

2021-04-10

Symptoms: No idea if its related to the vaccine but Ive been having a lot of breast tenderness on both sides. Not sure if its hormonally related but I will be talking to my gynecologist next week.

Release 7 — days 1–6 daily, dose 2

2021-04-20

Systemic reaction (other): Arm has been hot near the injection site the last few days

2021-04-22

Systemic reaction (other): Light headed and shaky in the AM

Release 10 — days 1–6 daily, dose 3

2021-11-16

Systemic reaction (other): First few days- frequent urination

2021-11-17

Systemic reaction (other): Have been having arm pit and breast tenderness on the injection side side day after shot

Release 10 — day 14, dose 3

2021-11-28

Symptoms: Nausea, diarrhea and vomiting- lasted a few days. No idea if it is separate from vaccine.

Release 10 — day 21, dose 3

2021-12-05

Symptoms: Stomach issues persist. Upset stomach and diarrhea on and off.

Release 10 — day 42, dose 3

2021-12-31

Symptoms: Stuffy nose sore throat body aches fatigue coughing

Release 11 — 6 months, dose 3

2022-05-16

Symptoms: Shortness of breath, tachycardia, fatigue, stomach issues, ringing ears. This has all been since I had Covid at the end of December. I believe this is related to getting Covid and not the vaccination

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	Abdominal discomfort	·	·	✓
SD	Breast tenderness	✓	✓	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nausea	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Tachycardia	·	·	✓
SD	Tinnitus	·	·	✓
SD	Vomiting	·	·	✓
SRO	Breast tenderness	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Injection site warmth	✓	✓	✓
SRO	Pollakiuria	·	·	✓
SRO	Tenderness	·	·	✓
SRO	Tremor	✓	✓	✓

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