ZJR-24609-06777

3 vaccinations 10 coded responses 37 check-ins 10 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 983 / WA
Registered: 2021-01-31

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

2021-01-30
Dose 1 — Moderna
2021-01-31
Registered in v-safe
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Diarrhea, Abdominal pain

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-20
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-27
Dose 2 — Moderna
2021-02-27
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-03-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Joint pains

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Joint pains, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Diarrhea

Adult check-in
2021-03-06
Health check-in — day 7, dose 2
Feeling: Good · Site: Swelling · Fever · None

Adult check-in
2021-03-13
Survey response — day 14, dose 2
MedDRA: Diarrhoea, Flatulence — Feeling: Fair

Free text: Continue to experience great deal of flatus and continued loose stool.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-10
Survey response — day 42, dose 2
MedDRA: Cough, Nasal congestion — Feeling: Good

Free text: Nasal congestion and cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-19
Dose 3 — Moderna
2021-08-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Headache · Be unable to do your normal daily activities

Adult check-in
2021-08-21
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Nausea, Vomiting, Diarrhea

Free text: Enlarged lymph nodes on left side arm and neck

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-22
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Muscle or body aches, Nausea, Vomiting

Free text: Swollen lymph nodes remain enlarged

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-23
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches

Free text: Lymph node swelling

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-08-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-08-26
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Muscle or body aches

Adult check-in
2021-09-02
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-09-09
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-09-16
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-09-23
Survey response — day 35, dose 3
MedDRA: Arthralgia, Injection site pain, Neck pain, Pre-existing disease — Feeling: Poor · 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: Excruciating pain at the site of the injection. I thought it was just arthritis but the pain is spreading up the neck and down to the elbow

MedDRA releases: 2024-11 · check-in free text available
2021-09-23
Report sent to call center — day 35, 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 · 1 call case(s)
2021-09-28
Call 1 — Left Voicemail
2021-09-30
Survey response — day 42, dose 3
MedDRA: Arthralgia, Infection, Injection site pain, Laboratory test abnormal — Feeling: Poor · 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: The pain in my left arm and shoulder the site of the additional dose has worsened since last night. I have a follow up with my rheumatologist on 10/20/21 but she is away right now. Lab work showed signs of infection. For follow up

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Report sent to call center — day 42, 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 · 1 call case(s)
2021-10-01
Call 1 — Left Voicemail
2021-11-18
Survey response — 3 months, dose 3
MedDRA: Arthralgia, Office visit, Shoulder injury related to vaccine administration — Feeling: Poor · 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: Symptoms: Continued and increasing pain in the left shoulder vaccination site · Healthcare visit (other): PT evaluation for SIRVA

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-19
Call 1 — Left Voicemail
2022-02-17
Survey response — 6 months, dose 3
MedDRA: Osteonecrosis, Unevaluable event — Feeling: Poor · 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: Symptoms: Avascular necrosis of the head of the humerus on the left arm where I received my third dose of Covid vaccine · Healthcare visit (other): Preparing for a shoulder replacement

MedDRA releases: 2024-11 · check-in free text available
2022-02-17
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-21
Call 1 — Left Voicemail
2022-08-19
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-30	Moderna
2	2021-02-27	Moderna
3	2021-08-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-23	Unsuccessful
2021-09-30	Unsuccessful
2021-11-18	Unsuccessful
2022-02-17	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): None

Release 5 — day 14, dose 2

2021-03-13

Symptoms: Continue to experience great deal of flatus and continued loose stool.

Release 7 — day 42, dose 2

2021-04-10

Symptoms: Nasal congestion and cough

Release 9 — days 1–6 daily, dose 3

2021-08-21

Systemic reaction (other): Enlarged lymph nodes on left side arm and neck

2021-08-22

Systemic reaction (other): Swollen lymph nodes remain enlarged

2021-08-23

Systemic reaction (other): Lymph node swelling

Release 9 — day 35, dose 3

2021-09-23

Symptoms: Excruciating pain at the site of the injection. I thought it was just arthritis but the pain is spreading up the neck and down to the elbow

Release 9 — day 42, dose 3

2021-09-30

Symptoms: The pain in my left arm and shoulder the site of the additional dose has worsened since last night. I have a follow up with my rheumatologist on 10/20/21 but she is away right now. Lab work showed signs of infection. For follow up

Release 10 — 3 months, dose 3

2021-11-18

Symptoms: Continued and increasing pain in the left shoulder vaccination site

Healthcare visit (other): PT evaluation for SIRVA

Release 11 — 6 months, dose 3

2022-02-17

Symptoms: Avascular necrosis of the head of the humerus on the left arm where I received my third dose of Covid vaccine

Healthcare visit (other): Preparing for a shoulder replacement

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	Office visit	·	·	✓
HCVO	Shoulder injury related to vaccine administration	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Arthralgia	·	·	✓
SD	Cough	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Flatulence	✓	✓	✓
SD	Infection	·	·	✓
SD	Injection site pain	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Nasal congestion	✓	✓	✓
SD	Neck pain	·	·	✓
SD	Osteonecrosis	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Lymphadenopathy	✓	·	✓
SRO	No adverse event	✓	✓	✓

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