3RZ-25754-77425

4 vaccinations 14 coded responses 41 check-ins 14 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 396 / MS
Registered: 2021-02-04

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-03
Dose 1 — Moderna
2021-02-04
Registered in v-safe
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Haematochezia — Feeling: Good

Free text: Blood in bowel movement this morning

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Haematochezia — Feeling: Good

Free text: Blood in stool again Sunday night trying to schedule a colonoscopy

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

Adult check-in
2021-02-10
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-17
Survey response — day 14, dose 1
MedDRA: Abdominal pain lower, Abdominal pain upper, Perineal injury, Vulvovaginal pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Lower stomach painMid to lower left side painVagina tear and inside pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — day 21, dose 1
MedDRA: Gastrointestinal disorder, Uterine prolapse — Feeling: Poor · Be unable to do your normal daily activities

Free text: Gastrointestinal trouble Uterus prolapse:Not sure if bladder and anything else has prolapsedCould not keep appointments due to snow and ice1 appointment coming up 2/26/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Dose 2 — Moderna
2021-03-02
Survey response — day 0, dose 2
MedDRA: Adverse reaction — Feeling: Good

Free text: Do not think the vaccine was injected properly!!! It was a waisted shot!! He simply pricked my arm and did not push needle in!! It was also not in the upper muscle!! How do I know if I was vaccinated properly or vaccinated at all??? What should I do???

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Something must have been injected

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain, Ear pain, Haematochezia, Headache — Feeling: Fair · Site: Swelling, Itching · Headache, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Free text: Headache and ear ache on left side of head last night through today off and on. Pain in abdomen and left side started last night through today. Blood in stool last night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Swelling, Itching · Headache, Joint pains, Abdominal pain

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Haematochezia — Feeling: Fair · Site: Swelling, Itching · Headache, Joint pains, Muscle or body aches, Abdominal pain

Free text: Blood in stool 2x yesterday and most of today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — day 7, dose 2
Feeling: Good · Site: Swelling · Joint pains, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-16
Survey response — day 14, dose 2
MedDRA: Nausea — Feeling: Good

Free text: Nausea for about 3 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-07
Survey response — 3 months, dose 2
MedDRA: Abdominal pain upper — Feeling: Fair · 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: Extreme stomach pain. CAT Scan done 6/1/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-07
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-31
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-05
Call 1 — Left Voicemail
2021-09-24
Call successful
Participant prefers to complete VAERS report online
2021-12-10
Dose 3 — Moderna
2021-12-14
Survey response — days 1–6 daily, dose 3
MedDRA: Chest pain — Feeling: Fair · Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: Pain in left side of chest

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Health check-in — day 7, dose 3
Feeling: Good · Headache, Muscle or body aches, Abdominal pain

Adult check-in
2021-12-24
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-07
Survey response — day 28, dose 3
MedDRA: Ear pruritus, Headache, Lymphadenopathy, Self-medication, Stomatitis — Feeling: Fair

Free text: Irritation in roof of mouth started yesterday 1/6/22; spreading today and moving towards my gums; Ears are a little itchy; glands a little irritated on both sides; mild head ache: Gargled with listerine yesterday and salt water today: Took Zyrtec bd

MedDRA releases: 2024-11 · check-in free text available
2022-01-14
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-22
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-11
Survey response — 3 months, dose 3
MedDRA: Blood potassium decreased, Blood urine present, Flatulence, Headache, Hypertension, Musculoskeletal stiffness, Protein urine, Red blood cell count decreased, Swelling, Throat irritation, 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: HBP: Blood in urine: Protein in urine: Low red blood count: Low potassium: Extreme swelling: Extreme headaches: Stiffness that is like paralysis: Extreme gas build up hard to pass or dissolve: Throat irritation: · Healthcare visit (other): Referred to kidney specialist

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
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)
2022-03-16
Call successful
Does not wish to fill out VAERS report
2022-06-13
Survey response — 6 months, dose 3
MedDRA: Condition aggravated, Hypertension, Laryngeal oedema, Office visit, Pre-existing disease, Throat irritation — 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: L4 is now bone on bone and pushing back Spinal Specialist has ordered a MRI Throat irritation with swelling around vocal cords and voice box Diagnosed with hypertension · Healthcare visit (other): ENT and Spinal Specialist and Primary Care

MedDRA releases: 2024-11 · check-in free text available
2022-06-13
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)
2022-06-14
Call successful
Does not wish to fill out VAERS report
2022-11-01
Dose 4 — Moderna
2022-11-09
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-11-16
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-30
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-12-08
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-02-01
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-05-03
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-03	Moderna
2	2021-03-02	Moderna
3	2021-12-10	Moderna	No
4	2022-11-01	Moderna	No

Call center

3 call center cases

3 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-05

Systemic reaction (other): Blood in bowel movement this morning

2021-02-08

Systemic reaction (other): Blood in stool again Sunday night trying to schedule a colonoscopy

Release 4 — day 14, dose 1

2021-02-17

Symptoms: Lower stomach painMid to lower left side painVagina tear and inside pain

Release 4 — day 21, dose 1

2021-02-24

Symptoms: Gastrointestinal trouble Uterus prolapse:Not sure if bladder and anything else has prolapsedCould not keep appointments due to snow and ice1 appointment coming up 2/26/21

Release 4 — day 0, dose 2

2021-03-02

Systemic reaction (other): Do not think the vaccine was injected properly!!! It was a waisted shot!! He simply pricked my arm and did not push needle in!! It was also not in the upper muscle!! How do I know if I was vaccinated properly or vaccinated at all??? What should I do???

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Something must have been injected

2021-03-04

Systemic reaction (other): Headache and ear ache on left side of head last night through today off and on. Pain in abdomen and left side started last night through today. Blood in stool last night

2021-03-06

Systemic reaction (other): Blood in stool 2x yesterday and most of today

Release 5 — day 14, dose 2

2021-03-16

Symptoms: Nausea for about 3 days

Release 8 — 3 months, dose 2

2021-06-07

Symptoms: Extreme stomach pain. CAT Scan done 6/1/21

Release 10 — days 1–6 daily, dose 3

2021-12-14

Systemic reaction (other): Pain in left side of chest

Release 10 — day 28, dose 3

2022-01-07

Symptoms: Irritation in roof of mouth started yesterday 1/6/22; spreading today and moving towards my gums; Ears are a little itchy; glands a little irritated on both sides; mild head ache: Gargled with listerine yesterday and salt water today: Took Zyrtec bd cut off by CDC

Release 11 — 3 months, dose 3

2022-03-11

Symptoms: HBP: Blood in urine: Protein in urine: Low red blood count: Low potassium: Extreme swelling: Extreme headaches: Stiffness that is like paralysis: Extreme gas build up hard to pass or dissolve: Throat irritation:

Healthcare visit (other): Referred to kidney specialist

Release 12 — 6 months, dose 3

2022-06-13

Symptoms: L4 is now bone on bone and pushing back Spinal Specialist has ordered a MRI Throat irritation with swelling around vocal cords and voice box Diagnosed with hypertension

Healthcare visit (other): ENT and Spinal Specialist and Primary Care

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	Unevaluable event	·	·	✓
SD	Abdominal pain lower	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Blood potassium decreased	·	·	✓
SD	Blood urine present	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Ear pruritus	·	·	✓
SD	Flatulence	·	·	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Headache	·	·	✓
SD	Hypertension	·	·	✓
SD	Laryngeal oedema	·	·	✓
SD	Lymphadenopathy	·	·	✓
SD	Musculoskeletal stiffness	·	·	✓
SD	Nausea	✓	✓	✓
SD	Perineal injury	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Protein urine	·	·	✓
SD	Red blood cell count decreased	·	·	✓
SD	Self-medication	·	·	✓
SD	Stomatitis	·	·	✓
SD	Swelling	·	·	✓
SD	Throat irritation	·	·	✓
SD	Uterine prolapse	✓	✓	✓
SD	Vulvovaginal pain	✓	✓	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Chest pain	·	·	✓
SRO	Ear pain	✓	✓	✓
SRO	Haematochezia	✓	✓	✓
SRO	Headache	✓	✓	✓

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