Y7J-10140-68011

2 vaccinations 11 coded responses 24 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 543 / WI
Registered: 2021-02-14

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

2021-02-13
Dose 1 — Moderna
2021-02-14
Registered in v-safe
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Disturbance in attention — Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Trouble concentrating

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Site: Pain, Redness · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Very very tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Fatigue — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Very tired and dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy, but not as bad as previously

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: When will this go away???

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-27
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-13
Dose 2 — Moderna
2021-03-13
Survey response — day 0, dose 2
MedDRA: Injection site pain — Feeling: Good · Site: Redness · Fatigue or tiredness

Free text: Injection site is beginning to ache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Good · Site: Swelling · Muscle or body aches, Fatigue or tiredness

Free text: Tenderness at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 2
MedDRA: Malaise, Pyrexia — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: I didn't take my temp, but felt slightly feverish. Felt very yucky today...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-19
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Hyperhidrosis, Insomnia — Feeling: Fair · Chills, Headache, Nausea

Free text: Last night i had chills, then sweating throughout the night. Couldn't sleep

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-20
Survey response — day 7, dose 2
MedDRA: Dizziness — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Very very dizzy...does this ever end

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — day 14, dose 2
MedDRA: Asthma, Office visit, Pre-existing disease — Feeling: Fair · 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: My asthma has flaired up last week. On Rx meds from Dr. In the last two days. · Healthcare visit (other): Called office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-12
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-03-09
Call 1 — Left Voicemail
2022-03-16
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-13	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-27	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-14

Systemic reaction (other): Trouble concentrating

2021-02-15

Systemic reaction (other): Very very tired

2021-02-16

Systemic reaction (other): Very tired and dizzy

2021-02-17

Systemic reaction (other): Dizzy, but not as bad as previously

2021-02-18

Systemic reaction (other): When will this go away???

Release 5 — day 0, dose 2

2021-03-13

Systemic reaction (other): Injection site is beginning to ache.

Release 5 — days 1–6 daily, dose 2

2021-03-16

Systemic reaction (other): Tenderness at injection site

2021-03-17

Systemic reaction (other): I didn't take my temp, but felt slightly feverish. Felt very yucky today...

2021-03-19

Systemic reaction (other): Last night i had chills, then sweating throughout the night. Couldn't sleep

Release 6 — day 7, dose 2

2021-03-20

Systemic reaction (other): Very very dizzy...does this ever end

Release 6 — day 14, dose 2

2021-03-27

Symptoms: My asthma has flaired up last week. On Rx meds from Dr. In the last two days.

Healthcare visit (other): Called office

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	Asthma	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Disturbance in attention	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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