Y7Z-23097-92005

4 vaccinations 11 coded responses 34 check-ins 11 free-text entries 12 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 191 / PA
Registered: 2021-03-19

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-19
Registered in v-safe
2021-03-19
Dose 1 — Moderna
2021-03-19
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Chills, Muscle or body aches

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-02
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-04-23
Dose 2 — Moderna
2021-04-23
Survey response — day 0, dose 2
MedDRA: Amnesia, Unevaluable event — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I cant remember anything, my mind is not functioning properly. · Healthcare visit (other): None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Report sent to call center — day 0, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-24
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-27
Survey response — days 1–6 daily, dose 2
MedDRA: Amnesia, Disturbance in attention, Unevaluable event — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Im experiencing difficulty focusing on anything, and I cant remember anything? I cannot focus??!! · Healthcare visit (other): None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-27
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Alopecia, Disturbance in attention, Unevaluable event — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I cannot focus, I cant remember anything my hair is falling out · Healthcare visit (other): None , because Im so sick of it

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-29
Survey response — days 1–6 daily, dose 2
MedDRA: Amnesia, Disturbance in attention, Headache — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, 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: My head hurts, I cant focus anymore, I cant remember whom I spoke to yesterday, my son tell me over and over that I keep repeating what we already discussed? I dont remember?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-30
Survey response — day 7, dose 2
MedDRA: Headache, No adverse event — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): My head hurts very much · Healthcare visit (other): None

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Report sent to call center — day 7, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-07
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-14
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-21
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-28
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-04
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-07-23
Survey response — 3 months, dose 2
MedDRA: Amnesia, Chills, Confusional state, Fall, Headache, Illness, Memory impairment, Myalgia, Pain, Pyrexia — 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 · Telehealth, virtual health, or email health consultation

Free text: I Got sick again fever headache chills body aches and muscle pain and Im experiencing loss of memory, I cant remember anything constantly confused, and I had several falls . I was on antibiotics 500 mg penicillin 3X a day for 2 weeks

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-23
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

1 call case(s)
2021-07-29
Call 3 — Left Voicemail
2021-10-22
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-22
Dose 3 — Moderna
Co-administered: Flu:Shingles:Tetanus
2022-04-23
Survey response — 12 months, dose 2
MedDRA: Nasopharyngitis, Office visit — Feeling: Fair · 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: I had a cold, and I was on antibiotics 500 mg of amoxicillin 3X a day for 2 weeks. · Healthcare visit (other): PCP

MedDRA releases: 2024-11 · check-in free text available
2022-04-23
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)
2022-04-25
Call 1 — Left Voicemail
2022-05-24
Dose 4 — Moderna
2022-05-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Adult check-in
2022-05-28
Survey response — 6 months, dose 3
MedDRA: Hemiparesis, Paraesthesia — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Left side weakness, tingling I thought I was having a stroke

MedDRA releases: 2024-11 · check-in free text available
2022-05-28
Report sent to call center — days 1–6 daily, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-28
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-31
Health check-in — day 7, dose 4
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Adult check-in
2022-05-31
Report sent to call center — day 7, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 2 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 1 — Left Voicemail
2022-06-01
Call 2 — Left Voicemail
2022-06-01
Call 2 — Left Voicemail
2022-06-01
Call 2 — Left Voicemail
2022-06-01
Call 3 — Left Voicemail
2022-06-01
Call 2 — Left Voicemail
2022-06-01
Call 2 — Left Voicemail
2022-06-01
Call 1 — Left Voicemail
2022-06-08
Health check-in — day 14, dose 4
Feeling: Fair

Adult check-in
2022-06-14
Survey response — day 21, dose 4
MedDRA: Blepharospasm, Muscle spasms, Office visit, Pain — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Muscle spasm excruciating pain when I move my arm.. my eye is constantly twitching, I have no energy??? · Healthcare visit (other): PCP

MedDRA releases: 2024-11 · check-in free text available
2022-06-14
Report sent to call center — day 21, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-15
Call 1 — Left Voicemail
2022-06-24
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-28
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-07-05
Survey response — day 42, dose 4
MedDRA: Asthenia, Cardiac disorder, Fatigue, Migraine, Muscle spasms — Feeling: Poor · Be unable to do your normal daily activities

Free text: Migraines to many migraines, muscle spasms, I'm tired all the time , my left side of my body is week. Sometimes I feel like im going to have a heart attack.

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-19	Moderna
2	2021-04-23	Moderna
3	2021-11-22	Moderna	Flu:Shingles:Tetanus
4	2022-05-24	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-23	Unsuccessful
2021-04-24	Unsuccessful
2021-04-27	Unsuccessful
2021-04-28	Unsuccessful
2021-04-29	Unsuccessful
2021-04-30	Unsuccessful
2021-07-23	Unsuccessful
2022-04-23	Unsuccessful
2022-05-28	Unsuccessful
2022-05-28	Unsuccessful
2022-05-31	Unsuccessful
2022-06-14	Unsuccessful

Free text

Release 7 — day 0, dose 2

2021-04-23

Systemic reaction (other): I cant remember anything, my mind is not functioning properly.

Healthcare visit (other): None

Release 7 — days 1–6 daily, dose 2

2021-04-24

Healthcare visit (other): None

Release 8 — days 1–6 daily, dose 2

2021-04-27

Systemic reaction (other): Im experiencing difficulty focusing on anything, and I cant remember anything? I cannot focus??!!

Healthcare visit (other): None

2021-04-28

Systemic reaction (other): I cannot focus, I cant remember anything my hair is falling out

Healthcare visit (other): None , because Im so sick of it

2021-04-29

Systemic reaction (other): My head hurts, I cant focus anymore, I cant remember whom I spoke to yesterday, my son tell me over and over that I keep repeating what we already discussed? I dont remember?

Release 8 — day 7, dose 2

2021-04-30

Systemic reaction (other): My head hurts very much

Healthcare visit (other): None

Release 9 — 3 months, dose 2

2021-07-23

Symptoms: I Got sick again fever headache chills body aches and muscle pain and Im experiencing loss of memory, I cant remember anything constantly confused, and I had several falls . I was on antibiotics 500 mg penicillin 3X a day for 2 weeks

Release 11 — 12 months, dose 2

2022-04-23

Symptoms: I had a cold, and I was on antibiotics 500 mg of amoxicillin 3X a day for 2 weeks.

Healthcare visit (other): PCP

Release 11 — 6 months, dose 3

2022-05-28

Symptoms: Left side weakness, tingling I thought I was having a stroke

Release 12 — day 21, dose 4

2022-06-14

Symptoms: Muscle spasm excruciating pain when I move my arm.. my eye is constantly twitching, I have no energy???

Healthcare visit (other): PCP

Release 12 — day 42, dose 4

2022-07-05

Symptoms: Migraines to many migraines, muscle spasms, I'm tired all the time , my left side of my body is week. Sometimes I feel like im going to have a heart attack.

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	No adverse event	✓	✓	✓
HCVO	Office visit	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Amnesia	✓	·	✓
SD	Asthenia	·	·	✓
SD	Blepharospasm	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Chills	✓	·	✓
SD	Confusional state	✓	·	✓
SD	Fall	✓	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	·	✓
SD	Hemiparesis	·	·	✓
SD	Illness	✓	·	✓
SD	Memory impairment	✓	·	✓
SD	Migraine	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Myalgia	✓	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pain	✓	·	✓
SD	Paraesthesia	·	·	✓
SD	Pyrexia	✓	·	✓
SRO	Alopecia	✓	✓	✓
SRO	Amnesia	✓	✓	✓
SRO	Disturbance in attention	✓	✓	✓
SRO	Headache	✓	✓	✓

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