AWZ-63926-87731

2 vaccinations 8 coded responses 16 check-ins 8 free-text entries 3 call cases

Sex: —
Age at first dose: 46-50
ZIP prefix: 730 / OK
Registered: 2021-06-01

Relationship: Self
Race: Other
Ethnicity: N/A

Timeline

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

2021-05-29
Dose 1 — Moderna
2021-06-01
Registered in v-safe
2021-06-01
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder — Feeling: Good · Site: Pain, Redness · Chills, Headache, Joint pains

Free text: BALANCE OFF MODERATE

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Swelling · Joint pains, Muscle or body aches

Free text: Light headedness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-06
Health check-in — day 7, dose 1
Feeling: Good · Fever · Headache

Adult check-in
2021-06-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-06-19
Survey response — day 21, dose 1
MedDRA: Back pain, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: ACHING BACK SORE LEGS

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-26
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-07-02
Dose 2 — Moderna
2021-07-03
Survey response — days 1–6 daily, dose 2
MedDRA: Contusion, Scratch — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Headache, Muscle or body aches, Nausea, Diarrhea

Free text: BRUISED FROM SCRATCHING

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-05
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-07-08
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling hot — Feeling: Fair · Site: Swelling · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Felt hot heated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-11
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Nausea

Adult check-in
2021-07-16
Survey response — day 14, dose 2
MedDRA: Fatigue, Medical counselling, Nausea, Pain in extremity — Feeling: Poor · Be unable to work or attend school, 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: Symptoms: FATIGUE..SORE FEET.. NAUSEATED · Healthcare visit (other): Pharmacy

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-16
Report sent to call center — day 14, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-07-19
Call 1 — Left Voicemail
2021-07-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-08-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-08-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-10-03
Survey response — 3 months, dose 2
MedDRA: Pneumonia — Feeling: Good · Be unable to work or attend school, 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: Caught pneumonia..had too take antibiotics..10days..

MedDRA releases: 2024-11 · check-in free text available
2021-10-03
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-06
Call 1 — Left Voicemail
2021-12-31
Survey response — 6 months, dose 2
MedDRA: Pneumonia — Feeling: Fair · Be unable to work or attend school, 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: Pnuemonia in the lungs

MedDRA releases: 2024-11 · check-in free text available
2021-12-31
Report sent to call center — 6 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-04
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-29	Moderna
2	2021-07-02	Moderna	No

Call center

3 call center cases

1 successful · 2 unsuccessful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 1

2021-06-01

Systemic reaction (other): BALANCE OFF MODERATE

2021-06-02

Systemic reaction (other): Light headedness

Release 9 — day 21, dose 1

2021-06-19

Symptoms: ACHING BACK SORE LEGS

Release 9 — days 1–6 daily, dose 2

2021-07-03

Systemic reaction (other): BRUISED FROM SCRATCHING

2021-07-08

Systemic reaction (other): Felt hot heated

Release 9 — day 14, dose 2

2021-07-16

Symptoms: FATIGUE..SORE FEET.. NAUSEATED

Healthcare visit (other): Pharmacy

Release 9 — 3 months, dose 2

2021-10-03

Symptoms: Caught pneumonia..had too take antibiotics..10days..

Release 10 — 6 months, dose 2

2021-12-31

Symptoms: Pnuemonia in the lungs

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	Medical counselling	✓	·	✓
SD	Back pain	✓	✓	✓
SD	Fatigue	✓	·	✓
SD	Nausea	✓	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pneumonia	·	·	✓
SRO	Balance disorder	✓	✓	✓
SRO	Contusion	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Scratch	✓	✓	✓

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