Y5Z-14506-28969

5 vaccinations 11 coded responses 40 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 840 / UT
Registered: 2021-02-04

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

2021-02-04
Registered in v-safe
2021-02-04
Dose 1 — Moderna
2021-02-04
Survey response — day 0, dose 1
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: Arm pain

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: Headache — Feeling: Good · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Free text: No, all but headache has been mild.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Eye irritation, Eye pain, Pre-existing disease, Rhinorrhoea — Feeling: Good · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Have been having some eye irritation and pain behind the eye. But, I don't know if that's related to the vaccine or not. I have allergies, asthma and get the occasional sinus infection. So, the eye pain could possibly be a sinus infection coming on with frequent, watery discharge from the left nasal cavity. Though both eyes are irritated, I'm only experiencing pain behind my left eye. That leads me to believe that the eye irritation and pain could be allergy or potential sinus infection related, instead.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Back pain, Neck pain — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Free text: Neck pain & back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-02-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-04
Dose 2 — Moderna
2021-03-04
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Oropharyngeal pain, Pain in extremity, Paranasal sinus hypersecretion, Sinus congestion — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Mild sinus congestion and drainage plus moderate sore throat. Moderate to severe pain in feet/ankles and hands/wrists.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Back pain, Fatigue, Oropharyngeal pain, Respiratory tract congestion — Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Free text: Sore throat, congested, pretty fatigued, less neck, shoulder, joint and back pain today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Neck pain, Oropharyngeal pain — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Free text: Neck & shoulder pain. Sore throat.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Neck pain, Oropharyngeal pain — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work

Free text: Sore throat, neck & shoulder pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-11
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-18
Health check-in — day 14, dose 2
Feeling: Poor

Adult check-in
2021-03-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-08
Survey response — day 35, dose 2
MedDRA: Headache — Feeling: Fair

Free text: That same covid headache got quite bad again today for awhile. I thought it had left weeks ago.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-03
Dose 3 — Moderna
2022-03-04
Survey response — 12 months, dose 2
MedDRA: Adverse drug reaction, Diarrhoea, Fatigue, Hypersensitivity, Malaise, Office visit, SARS-CoV-2 test negative, Self-medication, Urticaria — Feeling: Good · 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: Symptoms: Medication reaction to Xyzal and Terbinafine that produced a severe systemic reaction (severe diarrhea for 6 weeks, severe hives, fatigue, & a multitude of other symptoms) that acted like the latest strain of covid, but I had a negative PCR test. · Healthcare visit (other): Several Dr ofc visits

MedDRA releases: 2024-11 · check-in free text available
2022-03-04
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-08
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-08
Dose 4 — Moderna
2022-04-28
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-01
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-13
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-08
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-23
Dose 5 — Moderna
Co-administered: Flu
2022-09-29
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-09-30
Health check-in — day 7, dose 5
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-10-08
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-14
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-21
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-28
Survey response — day 35, dose 5
MedDRA: Feeling abnormal, Hospitalisation, Spinal fusion surgery — 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

Free text: Symptoms: 4 disk cervical fusion - no covid issues, but can't say I feel good today. · Healthcare visit (other): 1 night stay in hospital following cervical fusion. Discharged next day.

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Report sent to call center — day 35, dose 5
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)
2022-10-31
Call 1 — Left Voicemail
2022-11-01
Call 2 — Left Voicemail
2022-11-02
Call 3 — Left Voicemail
2022-11-03
Call successful
Not applicable - Accidental Reporting
2022-11-04
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-25
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2021-11-03	Moderna	No
4	2022-04-08	Moderna	No
5	2022-09-23	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2022-03-04	Successful 2022-03-08	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-10-28	Successful 2022-11-03	Not applicable - Accidental Reporting

Free text

Release 3 — day 0, dose 1

2021-02-04

Systemic reaction (other): Arm pain

Release 3 — days 1–6 daily, dose 1

2021-02-05

Systemic reaction (other): No, all but headache has been mild.

2021-02-08

Systemic reaction (other): Have been having some eye irritation and pain behind the eye. But, I don't know if that's related to the vaccine or not. I have allergies, asthma and get the occasional sinus infection. So, the eye pain could possibly be a sinus infection coming on with frequent, watery discharge from the left nasal cavity. Though both eyes are irritated, I'm only experiencing pain behind my left eye. That leads me to believe that the eye irritation and pain could be allergy or potential sinus infection related, instead.

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Neck pain & back pain

Release 5 — days 1–6 daily, dose 2

2021-03-05

Systemic reaction (other): Mild sinus congestion and drainage plus moderate sore throat. Moderate to severe pain in feet/ankles and hands/wrists.

2021-03-06

Systemic reaction (other): Sore throat, congested, pretty fatigued, less neck, shoulder, joint and back pain today.

2021-03-07

Systemic reaction (other): Neck & shoulder pain. Sore throat.

2021-03-08

Systemic reaction (other): Sore throat, neck & shoulder pain.

Release 7 — day 35, dose 2

2021-04-08

Symptoms: That same covid headache got quite bad again today for awhile. I thought it had left weeks ago.

Release 11 — 12 months, dose 2

2022-03-04

Symptoms: Medication reaction to Xyzal and Terbinafine that produced a severe systemic reaction (severe diarrhea for 6 weeks, severe hives, fatigue, & a multitude of other symptoms) that acted like the latest strain of covid, but I had a negative PCR test.

Healthcare visit (other): Several Dr ofc visits

Release 12 — day 35, dose 5

2022-10-28

Symptoms: 4 disk cervical fusion - no covid issues, but can't say I feel good today.

Healthcare visit (other): 1 night stay in hospital following cervical fusion. Discharged next day.

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	Hospitalisation	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	Spinal fusion surgery	·	·	✓
SD	Adverse drug reaction	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Feeling abnormal	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypersensitivity	·	·	✓
SD	Malaise	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Self-medication	·	·	✓
SD	Spinal fusion surgery	·	·	✓
SD	Urticaria	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Eye irritation	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paranasal sinus hypersecretion	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sinus congestion	✓	✓	✓

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