4NZ-58891-21099

5 vaccinations 11 coded responses 52 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 853 / AZ
Registered: 2021-02-23

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

2021-02-22
Dose 1 — Moderna
2021-02-23
Registered in v-safe
2021-02-23
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Also mild difficulty breathing after walking dog and I have never experienced that before, ever, even when sick with covid. So far milder than symptoms from when I had covid-19 in early November and I did not expect to have any side effects from first vaccine dose yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-01
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-30
Dose 2 — Moderna
2021-03-30
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Lymphadenopathy, Oropharyngeal pain — Feeling: Poor · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Ear pain, aore throat, swollen glands

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

Free text: Ear pain, urinary tract infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Urinary tract infection — Feeling: Good · Fatigue or tiredness

Free text: Ear ache, Urinary tract infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Urinary tract infection — Feeling: Fair

Free text: Ear ache, urinary tract infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — day 7, dose 2
MedDRA: Ear pain, Urinary tract infection — Feeling: Good

Free text: Ear ache, urinary tract infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-20
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-28
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-02
Dose 3 — Moderna
2021-11-02
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Hypoaesthesia, Neck pain, Pain in extremity — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Severe pain & numbness down injection arm & fingers and up into the shoulder/neck on that side

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-05
Survey response — days 1–6 daily, dose 3
MedDRA: Neuralgia, Neuropathy peripheral, Tenderness — Feeling: Good

Free text: Tenderness/nerve pain/neuropathy on left side of face, same side the shot was given

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Hypoaesthesia — Feeling: Good

Free text: Facial numbness left side, same side as injection

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-10
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-16
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-09
Survey response — day 35, dose 3
MedDRA: Facial pain, Hypoaesthesia, Office visit, Trigeminal neuralgia — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Facial numbness/pain/neuralgia on one side. Perhaps unrelated to vaccine but FYI. · Healthcare visit (other): Chiropractor to release neck/nerve to see if that helped but it did not. Trying to figure out who to see next.

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-14
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-01
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-12
Dose 4 — Moderna
2022-04-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-04-26
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-05
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-12
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-04
Dose 5 — Moderna
2022-10-10
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-11
Survey response — day 7, dose 5
MedDRA: Dizziness, Hypoaesthesia, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Dizziness, numbness in hands but probably not related to vaccine · Healthcare visit (other): Chiropractic

MedDRA releases: 2024-11 · check-in free text available
2022-10-11
Report sent to call center — day 7, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-12
Call successful
Does not wish to fill out VAERS report
2022-10-25
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-01
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-15
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-05
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-06
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-22	Moderna
2	2021-03-30	Moderna
3	2021-11-02	Moderna	No
4	2022-04-12	Moderna	No
5	2022-10-04	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-23

Systemic reaction (other): Also mild difficulty breathing after walking dog and I have never experienced that before, ever, even when sick with covid. So far milder than symptoms from when I had covid-19 in early November and I did not expect to have any side effects from first vaccine dose yesterday.

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): Ear pain, aore throat, swollen glands

2021-04-03

Systemic reaction (other): Ear pain, urinary tract infection

2021-04-04

Systemic reaction (other): Ear ache, Urinary tract infection

2021-04-05

Systemic reaction (other): Ear ache, urinary tract infection

Release 7 — day 7, dose 2

2021-04-06

Systemic reaction (other): Ear ache, urinary tract infection

Release 10 — days 1–6 daily, dose 3

2021-11-03

Systemic reaction (other): Severe pain & numbness down injection arm & fingers and up into the shoulder/neck on that side

2021-11-05

Systemic reaction (other): Tenderness/nerve pain/neuropathy on left side of face, same side the shot was given

2021-11-06

Systemic reaction (other): Facial numbness left side, same side as injection

Release 10 — day 35, dose 3

2021-12-09

Symptoms: Facial numbness/pain/neuralgia on one side. Perhaps unrelated to vaccine but FYI.

Healthcare visit (other): Chiropractor to release neck/nerve to see if that helped but it did not. Trying to figure out who to see next.

Release 12 — day 7, dose 5

2022-10-11

Systemic reaction (other): Dizziness, numbness in hands but probably not related to vaccine

Healthcare visit (other): Chiropractic

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	·	·	✓
SD	Facial pain	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Trigeminal neuralgia	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Hypoaesthesia	·	·	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Neck pain	·	·	✓
SRO	Neuralgia	·	·	✓
SRO	Neuropathy peripheral	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Tenderness	·	·	✓
SRO	Trigeminal neuralgia	·	·	○
SRO	Urinary tract infection	✓	✓	✓

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