3ZS-20053-90549

2 vaccinations 10 coded responses 24 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 777 / TX
Registered: 2021-03-08

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

Registered dependents

MJ6-31378-41000 Child or adolescent in my care · Female · 2021-07-11

WNY-26316-38011 Child or adolescent in my care · Female · 2021-07-31

Timeline

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

2021-03-08
Registered in v-safe
2021-03-08
Dose 1 — Moderna
2021-03-08
Health check-in — day 0, dose 1
Feeling: Good · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Chills

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Itching · Fatigue or tiredness

Adult check-in
2021-03-12
Survey response — days 1–6 daily, dose 1
MedDRA: Heart rate increased — Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Free text: On last night I had a high heartbeat but havent had it today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-15
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-22
Survey response — day 14, dose 1
MedDRA: Injection site pruritus, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain in back of leg ,injection sight still itches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-05
Dose 2 — Moderna
2021-04-05
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Back pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Loss appetite a little

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Chills

Adult check-in
2021-04-12
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-04-19
Survey response — day 14, dose 2
MedDRA: Chills, Cough, Injection site pruritus, Nasopharyngitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe cough and cold for 3days in bed with chills but no fever. Very weak from it.Doing better after taking cough meds. Injection sight still itches and stomach sore from coughing hard.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Survey response — day 21, dose 2
MedDRA: Cough — Feeling: Fair · Be unable to do your normal daily activities

Free text: Coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — day 28, dose 2
MedDRA: Cough — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Excessive dry coughing .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Survey response — day 35, dose 2
MedDRA: Cough, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Excruciating coughing and extra fatigue. Ive tried lots of over the counter meds but its still on going.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Survey response — day 42, dose 2
MedDRA: Cough — Feeling: Good

Free text: Excessive coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Survey response — 3 months, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Shortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-08
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-08	Moderna
2	2021-04-05	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-12

Systemic reaction (other): On last night I had a high heartbeat but havent had it today.

Release 6 — day 14, dose 1

2021-03-22

Symptoms: Pain in back of leg ,injection sight still itches.

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Back pain.

2021-04-07

Systemic reaction (other): Loss appetite a little

Release 7 — day 14, dose 2

2021-04-19

Symptoms: Severe cough and cold for 3days in bed with chills but no fever. Very weak from it.Doing better after taking cough meds. Injection sight still itches and stomach sore from coughing hard.

Release 8 — day 21, dose 2

2021-04-27

Symptoms: Coughing

Release 8 — day 28, dose 2

2021-05-03

Symptoms: Excessive dry coughing .

Release 8 — day 35, dose 2

2021-05-10

Symptoms: Excruciating coughing and extra fatigue. Ive tried lots of over the counter meds but its still on going.

Release 8 — day 42, dose 2

2021-05-17

Symptoms: Excessive coughing

Release 9 — 3 months, dose 2

2021-07-05

Symptoms: Shortness of breath

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	Chills	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓

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