YM9-78936-47335

3 vaccinations 12 coded responses 28 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 799 / TX
Registered: 2021-05-27

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-04-27
Dose 1 — Moderna
2021-05-26
Dose 2 — Moderna
2021-05-27
Registered in v-safe
2021-05-27
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Dizziness, Palpitations — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Heart palpitations, felt faint upon standing, extreme weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite — Feeling: Fair · Site: Pain, Itching · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No appetite since getting the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-30
Survey response — days 1–6 daily, dose 2
MedDRA: Ageusia, Decreased appetite — Feeling: Good · Fatigue or tiredness

Free text: No appetite, no tatste

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-06-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-02
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-06-09
Survey response — day 14, dose 2
MedDRA: Rash — Feeling: Good

Free text: Have a mild rash on my arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-23
Survey response — day 28, dose 2
MedDRA: Brain fog, Memory impairment — Feeling: Good

Free text: My memory and recognition feels a little foggy at times. Not drastic although noticeable and a little unnerving.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-28
Survey response — 3 months, dose 2
MedDRA: Anxiety, Cough, Fatigue, Headache, Pyrexia, Respiratory tract congestion — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Headache, congestion, cough, fatigue, fever, anxiety

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-05
Dose 3 — Moderna
2022-04-05
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-04-06
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Decreased appetite — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: No appetite, cough

MedDRA releases: 2024-11 · check-in free text available
2022-04-07
Survey response — days 1–6 daily, dose 3
MedDRA: Brain fog, Hypotension, Lip pain, Memory impairment, Oral herpes, Palpitations — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Muscle or body aches, Fatigue or tiredness

Free text: Very bad Fever Blisters and pain on my lips, fogginess, forgetfulness--Had Heart palpitations/low lood preasure the first two days that I forgot to note.

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Oral herpes — Feeling: Good · Site: Itching · Muscle or body aches, Fatigue or tiredness

Free text: Cough, fever blisters

MedDRA releases: 2024-11 · check-in free text available
2022-04-09
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Good · Site: Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Coughing

MedDRA releases: 2024-11 · check-in free text available
2022-04-10
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Good · Site: Itching · Muscle or body aches, Fatigue or tiredness

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2022-04-12
Health check-in — day 7, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-04-19
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-04-26
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-05-03
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-05-10
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-05-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-07-05
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2023-04-05
Survey response — 12 months, dose 3
MedDRA: Arthralgia, Fatigue — 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

MedDRA releases: 2024-11
2023-04-05
Report sent to call center — 12 months, dose 3
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)
2023-04-07
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-27	Moderna
2	2021-05-26	Moderna
3	2022-04-05	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2023-04-05	Unsuccessful

Free text

Release 8 — days 1–6 daily, dose 2

2021-05-27

Systemic reaction (other): Heart palpitations, felt faint upon standing, extreme weakness

2021-05-28

Systemic reaction (other): No appetite since getting the shot

2021-05-30

Systemic reaction (other): No appetite, no tatste

Release 8 — day 14, dose 2

2021-06-09

Symptoms: Have a mild rash on my arm.

Release 9 — day 28, dose 2

2021-06-23

Symptoms: My memory and recognition feels a little foggy at times. Not drastic although noticeable and a little unnerving.

Release 9 — 3 months, dose 2

2021-08-28

Symptoms: Headache, congestion, cough, fatigue, fever, anxiety

Release 11 — days 1–6 daily, dose 3

2022-04-06

Systemic reaction (other): No appetite, cough

2022-04-07

Systemic reaction (other): Very bad Fever Blisters and pain on my lips, fogginess, forgetfulness--Had Heart palpitations/low lood preasure the first two days that I forgot to note.

2022-04-08

Systemic reaction (other): Cough, fever blisters

2022-04-09

Systemic reaction (other): Coughing

2022-04-10

Systemic reaction (other): Cough

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
SD	Anxiety	✓	·	✓
SD	Arthralgia	·	·	✓
SD	Brain fog	✓	✓	✓
SD	Cough	✓	·	✓
SD	Fatigue	✓	·	✓
SD	Headache	✓	·	✓
SD	Memory impairment	✓	✓	✓
SD	Pyrexia	✓	·	✓
SD	Rash	✓	✓	✓
SD	Respiratory tract congestion	✓	·	✓
SRO	Ageusia	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Brain fog	·	·	✓
SRO	Cough	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Hypotension	·	·	✓
SRO	Lip pain	·	·	✓
SRO	Memory impairment	·	·	✓
SRO	Oral herpes	·	·	✓
SRO	Palpitations	✓	✓	✓

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