3GM-12074-50417

2 vaccinations 10 coded responses 17 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 183 / PA
Registered: 2021-01-22

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

2021-01-21
Dose 1 — Moderna
2021-01-22
Registered in v-safe
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Emotional distress — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Overall feeling of distress

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Constipation, Fatigue — Feeling: Fair · Site: Pain · Chills, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Overall tiredness. Constipation which is unusual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-28
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

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

Adult check-in
2021-02-20
Dose 2 — Moderna
2021-02-20
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · 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: Systemic reaction (other): Complete fatigue inability to perform Simple tasks · Healthcare visit (other): Complete fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Constipation — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Constipation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Survey response — days 1–6 daily, dose 2
MedDRA: Constipation — Feeling: Poor · Site: Itching · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Constipation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Depression — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Feelings of deptession

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Survey response — day 7, dose 2
MedDRA: Diarrhoea — Feeling: Poor · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Loose stools

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — day 14, dose 2
MedDRA: Dizziness, Medical counselling — 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, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Today light headed almost faint completely new to my normal. Have there been reports of Covid after vaccine? · Healthcare visit (other): Called walk in center locally. Advised returning to original provider of vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-13
Survey response — day 21, dose 2
MedDRA: Dizziness, Emergency care, Office visit, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities

Free text: Feeling faint. Dizzy. Blurred vision. Visited ER at (b)(6) Followed up with primary care physician. Would appreciate a phone call to discuss continued side effects. (b)(6)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-08-17
Call 1 — Left Voicemail
2021-08-18
Call successful
Participant prefers to complete VAERS report online
2021-08-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-20
Survey response — 12 months, dose 2
MedDRA: Herpes zoster — Feeling: Poor · Be unable to do your normal daily activities

Free text: Developed shingles

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-20	Moderna

Call center

2 call center cases

2 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): Overall feeling of distress

2021-01-23

Systemic reaction (other): Overall tiredness. Constipation which is unusual

Release 4 — days 1–6 daily, dose 2

2021-02-21

Systemic reaction (other): Complete fatigue inability to perform Simple tasks

Healthcare visit (other): Complete fatigue

2021-02-22

Systemic reaction (other): Constipation

2021-02-23

Systemic reaction (other): Constipation

2021-02-25

Systemic reaction (other): Feelings of deptession

Release 4 — day 7, dose 2

2021-02-27

Systemic reaction (other): Loose stools

Release 5 — day 14, dose 2

2021-03-06

Symptoms: Today light headed almost faint completely new to my normal. Have there been reports of Covid after vaccine?

Healthcare visit (other): Called walk in center locally. Advised returning to original provider of vaccine

Release 5 — day 21, dose 2

2021-03-13

Symptoms: Feeling faint. Dizzy. Blurred vision. Visited ER at (b)(6) Followed up with primary care physician. Would appreciate a phone call to discuss continued side effects. (b)(6)

redacted (b)(6)

Release 11 — 12 months, dose 2

2022-02-20

Symptoms: Developed shingles

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	Fatigue	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Herpes zoster	·	·	✓
SD	Office visit	✓	✓	✓
SD	Vision blurred	✓	✓	✓
SRO	Constipation	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Emotional distress	✓	✓	✓
SRO	Fatigue	✓	✓	✓

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