Y4Y-23551-22665

5 vaccinations 16 coded responses 35 check-ins 16 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 787 / TX
Registered: 2021-01-10

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-01-09
Dose 1 — Moderna
2021-01-10
Registered in v-safe
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness · None

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site pain, Injection site warmth, Self-medication, Telemedicine — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Like I did on the second day after first vaccine, I had aching at injection site on Monday at 7pm then redness and warmth came on fast. Telemed visit dr Norris on Tuesday he not surprised since react meds said take benedryl 25mg before second vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-30
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-06
Dose 2 — Moderna
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain, Skin warm — Feeling: Good · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness

Free text: Right arm has been warm but no redness or swelling so far. Aching from lower right arm up to shoulder area and around injection site

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

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-13
Health check-in — day 7, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-13
Survey response — day 35, dose 2
MedDRA: Alopecia, Insomnia, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: My hair has been falling out for over a month. Dr did labs. All normal but my thyroid has lowered even though still in range. Hard time sleeping. Not sure if hair color has any effect on hair falling out never has before. Growing in length thin top · Healthcare visit (other): Got lab work/messages

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-20
Survey response — day 42, dose 2
MedDRA: Anxiety, Feeling of body temperature change, Sleep disorder, Unevaluable event, Weight decreased — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Lost 22 pounds. Anxiety. Difficulty sleeping. Have telemed appt dr Tuesday morn. Possible thyroid med change and more lab. Feel cold a lot. · Healthcare visit (other): Upcoming telemed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-02
Call 2 — Left Voicemail
2021-05-08
Survey response — 3 months, dose 2
MedDRA: Alopecia, Burning sensation, Insomnia, Oral surgery, Paraesthesia, Tooth extraction — Feeling: Good

Free text: Have had tingling in legs like pins sticking into left calf and some burning sensations. Not sleeping well. Thyroid test is Monday hair continues to fall out slightly. Had oral surgery extraction of tooth so all tied into lack of sleep

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-07
Survey response — 6 months, dose 2
MedDRA: Injection site erythema, Injection site pain, Medical counselling, Pyrexia — Feeling: Good

Free text: Had shingrix vaccine on 6/25 ; temp 102 and high 100s 4 plus days ; pain/redness at site of injection. second dose -on 8/25. Dr notified by phone

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-14
Dose 3 — Moderna
2021-10-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-26
Health check-in — day 42, dose 3
Feeling: Good

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

Adult check-in
2022-03-15
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-05
Dose 4 — Moderna
2022-04-14
Survey response — day 7, dose 4
MedDRA: Body temperature increased, Cough, Nasal congestion — Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Nasal congestion ran temp 99-100 plus on April 6 and April 7. Small cough.

MedDRA releases: 2024-11 · check-in free text available
2022-04-19
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-26
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-05
Survey response — 3 months, dose 4
MedDRA: Office visit, Pollakiuria — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Have been to my Dr a few weeks ago as I am having frequent urination. I do drink a lot of water and hydrate a lot. Had UA. Am considering a return to Dr for another UA to be sure I don't have an infection. · Healthcare visit (other): Ran UA lab and saw my Dr.

MedDRA releases: 2024-11 · check-in free text available
2022-07-05
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-07-06
Call 2 — Left Voicemail
2022-07-06
Call 2 — Left Voicemail
2022-07-06
Call 3 — Left Voicemail
2022-07-06
Call 2 — Left Voicemail
2022-09-28
Dose 5 — Moderna
2022-09-29
Survey response — days 1–6 daily, dose 5
MedDRA: No adverse event — Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tiredness

Free text:

MedDRA releases: 2024-11 · check-in free text available
2022-09-30
Survey response — days 1–6 daily, dose 5
MedDRA: Body temperature increased, Headache, Injection site erythema, Pain in extremity, Respiratory tract congestion — Feeling: Good · Site: Pain, Redness, Itching

Free text: Yesterday at injection sir was mildly red and about 2 inches below injection site a quarter size redness have had yesterday and today. I did have fluzone vaccine last Wednesday September 21 ran 99.9 temp and sore arm. Some congestion. Headache but th

MedDRA releases: 2024-11 · check-in free text available
2022-10-01
Survey response — days 1–6 daily, dose 5
MedDRA: Injection site erythema — Feeling: Good · Site: Redness, Itching

Free text: Only side effect still remaining I mildly red below injection site but it is size of 59 cent piece now larger area than yesterday. But no other side effects.

MedDRA releases: 2024-11 · check-in free text available
2022-10-02
Survey response — days 1–6 daily, dose 5
MedDRA: Injection site erythema — Feeling: Good · Site: Redness, Itching

Free text: I believe the area below my injection site has gotten less red and improving.

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Survey response — days 1–6 daily, dose 5
MedDRA: Injection site discolouration — Feeling: Good · Site: Itching

Free text: I can barely detect a light discoloration not redness a couple of inches below injection site.

MedDRA releases: 2024-11 · check-in free text available
2022-10-04
Survey response — days 1–6 daily, dose 5
MedDRA: Injection site erythema — Feeling: Good

Free text: The area 2inches down from injection site is barely little bit red. Improving almost normal skin color.

MedDRA releases: 2024-11 · check-in free text available
2022-10-05
Survey response — day 7, dose 5
MedDRA: Injection site discolouration — Feeling: Good

Free text: I am on my way to returning to normal skin color below site of injection.

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
Survey response — 3 months, dose 5
MedDRA: Artificial crown procedure, Decreased appetite, Gastrointestinal disorder, Gingival bleeding, Gingival pain, Lip exfoliation, Office visit, Oral mucosal exfoliation, Skin exfoliation, Tooth fracture — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Having dental issues had to go back and have chipped fro teetn worked on. 2 times painful gums bleeding and skin peeling off my lips and gums. Two dentist created permanent crowns. Hard to eat and digestive problems. Is better with each passing day · Healthcare visit (other): Dentist office. Not my medical family practice Dr. Dr

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
Report sent to call center — 3 months, dose 5
Get care from a doctor or other healthcare professional

1 call case(s)
2023-01-03
Call 1 — Left Voicemail
2023-01-03
Call 1 — Left Voicemail
2023-01-03
Call 1 — Left Voicemail
2023-01-03
Call 1 — Left Voicemail
2023-01-03
Call 1 — Left Voicemail
2023-03-29
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-09	Moderna
2	2021-02-06	Moderna
3	2021-09-14	Moderna	No
4	2022-04-05	Moderna	No
5	2022-09-28	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-23	Unsuccessful
2021-03-13	Unsuccessful
2021-03-20	Unsuccessful
2022-07-05	Unsuccessful
2022-12-30	Unsuccessful

Free text

Release 2 — day 14, dose 1

2021-01-23

Symptoms: Like I did on the second day after first vaccine, I had aching at injection site on Monday at 7pm then redness and warmth came on fast. Telemed visit dr Norris on Tuesday he not surprised since react meds said take benedryl 25mg before second vaccine cut off by CDC

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): Right arm has been warm but no redness or swelling so far. Aching from lower right arm up to shoulder area and around injection site

Release 5 — day 35, dose 2

2021-03-13

Symptoms: My hair has been falling out for over a month. Dr did labs. All normal but my thyroid has lowered even though still in range. Hard time sleeping. Not sure if hair color has any effect on hair falling out never has before. Growing in length thin top cut off by CDC

Healthcare visit (other): Got lab work/messages

Release 6 — day 42, dose 2

2021-03-20

Symptoms: Lost 22 pounds. Anxiety. Difficulty sleeping. Have telemed appt dr Tuesday morn. Possible thyroid med change and more lab. Feel cold a lot.

Healthcare visit (other): Upcoming telemed

Release 8 — 3 months, dose 2

2021-05-08

Symptoms: Have had tingling in legs like pins sticking into left calf and some burning sensations. Not sleeping well. Thyroid test is Monday hair continues to fall out slightly. Had oral surgery extraction of tooth so all tied into lack of sleep

Release 9 — 6 months, dose 2

2021-08-07

Symptoms: Had shingrix vaccine on 6/25 ; temp 102 and high 100s 4 plus days ; pain/redness at site of injection. second dose -on 8/25. Dr notified by phone

Release 11 — day 7, dose 4

2022-04-14

Systemic reaction (other): Nasal congestion ran temp 99-100 plus on April 6 and April 7. Small cough.

Release 12 — 3 months, dose 4

2022-07-05

Symptoms: Have been to my Dr a few weeks ago as I am having frequent urination. I do drink a lot of water and hydrate a lot. Had UA. Am considering a return to Dr for another UA to be sure I don't have an infection.

Healthcare visit (other): Ran UA lab and saw my Dr.

Release 12 — days 1–6 daily, dose 5

2022-09-29

2022-09-30

Systemic reaction (other): Yesterday at injection sir was mildly red and about 2 inches below injection site a quarter size redness have had yesterday and today. I did have fluzone vaccine last Wednesday September 21 ran 99.9 temp and sore arm. Some congestion. Headache but th cut off by CDC

2022-10-01

Systemic reaction (other): Only side effect still remaining I mildly red below injection site but it is size of 59 cent piece now larger area than yesterday. But no other side effects.

2022-10-02

Systemic reaction (other): I believe the area below my injection site has gotten less red and improving.

2022-10-03

Systemic reaction (other): I can barely detect a light discoloration not redness a couple of inches below injection site.

2022-10-04

Systemic reaction (other): The area 2inches down from injection site is barely little bit red. Improving almost normal skin color.

Release 12 — day 7, dose 5

2022-10-05

Systemic reaction (other): I am on my way to returning to normal skin color below site of injection.

Release 12 — 3 months, dose 5

2022-12-30

Symptoms: Having dental issues had to go back and have chipped fro teetn worked on. 2 times painful gums bleeding and skin peeling off my lips and gums. Two dentist created permanent crowns. Hard to eat and digestive problems. Is better with each passing day cut off by CDC

Healthcare visit (other): Dentist office. Not my medical family practice Dr. Dr

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	Alopecia	✓	✓	✓
SD	Anxiety	✓	✓	✓
SD	Artificial crown procedure	·	·	✓
SD	Burning sensation	✓	✓	✓
SD	Decreased appetite	·	·	✓
SD	Feeling of body temperature change	✓	✓	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Gingival bleeding	·	·	✓
SD	Gingival pain	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site warmth	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Lip exfoliation	·	·	✓
SD	Medical counselling	✓	·	✓
SD	Office visit	·	·	✓
SD	Oral mucosal exfoliation	·	·	✓
SD	Oral surgery	✓	✓	✓
SD	Paraesthesia	✓	✓	✓
SD	Pollakiuria	·	·	✓
SD	Pyrexia	✓	·	✓
SD	Self-medication	✓	✓	✓
SD	Skin exfoliation	·	·	✓
SD	Sleep disorder	✓	✓	✓
SD	Telemedicine	✓	✓	✓
SD	Tooth extraction	✓	✓	✓
SD	Tooth fracture	·	·	✓
SD	Weight decreased	✓	✓	✓
SRO	Body temperature increased	·	·	✓
SRO	Cough	·	·	✓
SRO	Headache	·	·	✓
SRO	Injection site discolouration	·	·	✓
SRO	Injection site erythema	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Nasal congestion	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Respiratory tract congestion	·	·	✓
SRO	Skin warm	✓	✓	✓

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