3ZD-30496-00636

2 vaccinations 8 coded responses 13 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 629 / IL
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 · Chills, Headache, Muscle or body aches, Diarrhea

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Diarrhea

Adult check-in
2021-02-02
Survey response — days 1–6 daily, dose 1
MedDRA: Dysgeusia, Hypoaesthesia, Sinus disorder — Feeling: Fair · Headache, Diarrhea

Free text: Yes, at the time of the injection, it made a weird taste in my mouth/sinus area. This only lasted a few seconds, not long. I also had a numbness in the left side of my face. It is much improved.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Office visit, Pre-existing disease, Sinusitis — Feeling: Fair · Headache, Diarrhea · Get care from a doctor or other healthcare professional

Free text: My regular GP. I wanted advise on the headache. I feel certain they are associated with a sinus infection that was going on before I got the Covid shot,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-04
Survey response — days 1–6 daily, dose 1
MedDRA: Headache — Feeling: Good · Headache

Free text: I only had a slight headache today. Much improved.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Good · Headache

Free text: Underneath (b)(6) I the empire area has hurt today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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
Survey response — day 21, dose 1
MedDRA: Headache, Hypoaesthesia, Muscular weakness, Office visit, Oral herpes, SARS-CoV-2 test negative, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: I still have numbness in the left side of my face. It is better , but there. Also my left arm muscles feel weak. I have had a few hives and fever blisters. Is it safe to take a 2nd shot? I have my pharmacist researching. It is due 2-24-21. · Healthcare visit (other): I went to the doc Mar. 11 and got a meg. Covid test. I got an antibiotic that gave relief from the headaches .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-24
Dose 2 — Moderna
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Pyrexia — Feeling: Good · Site: Redness, Itching · Be unable to work, Be unable to do your normal daily activities

Free text: This is my 3rd day. I got my shot on Wen. 2-24. On 2-25 I had a fever 101.6 and chills. It lasted about 24 hrs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-03
Survey response — day 7, dose 2
MedDRA: Arthritis — Feeling: Good · Joint pains

Free text: I have arthritis and the last 2 days it has been worse.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — day 14, dose 2
MedDRA: Dry eye, Muscle spasms, Pain — Feeling: Good

Free text: Dry dry eyes. I also have a cramping on the left side of my abdomen, just like I did with the first shot. The first time the pain left in about 3 weeks.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-29
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-30	Moderna
2	2021-02-24	Moderna

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-02

Systemic reaction (other): Yes, at the time of the injection, it made a weird taste in my mouth/sinus area. This only lasted a few seconds, not long. I also had a numbness in the left side of my face. It is much improved.

2021-02-03

Healthcare visit (other): My regular GP. I wanted advise on the headache. I feel certain they are associated with a sinus infection that was going on before I got the Covid shot,

2021-02-04

Systemic reaction (other): I only had a slight headache today. Much improved.

2021-02-05

Systemic reaction (other): Underneath (b)(6) I the empire area has hurt today.

redacted (b)(6)

Release 4 — day 21, dose 1

2021-02-20

Symptoms: I still have numbness in the left side of my face. It is better , but there. Also my left arm muscles feel weak. I have had a few hives and fever blisters. Is it safe to take a 2nd shot? I have my pharmacist researching. It is due 2-24-21.

Healthcare visit (other): I went to the doc Mar. 11 and got a meg. Covid test. I got an antibiotic that gave relief from the headaches .

Release 4 — days 1–6 daily, dose 2

2021-02-27

Systemic reaction (other): This is my 3rd day. I got my shot on Wen. 2-24. On 2-25 I had a fever 101.6 and chills. It lasted about 24 hrs.

Release 5 — day 7, dose 2

2021-03-03

Systemic reaction (other): I have arthritis and the last 2 days it has been worse.

Release 5 — day 14, dose 2

2021-03-10

Symptoms: Dry dry eyes. I also have a cramping on the left side of my abdomen, just like I did with the first shot. The first time the pain left in about 3 weeks.

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	Headache	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Pre-existing disease	✓	✓	✓
HCVO	SARS-CoV-2 test negative	✓	✓	✓
HCVO	Sinusitis	✓	✓	✓
SD	Dry eye	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Muscular weakness	✓	✓	✓
SD	Oral herpes	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Urticaria	✓	✓	✓
SRO	Arthritis	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Sinus disorder	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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