YZA-14408-04303

3 vaccinations 13 coded responses 27 check-ins 13 free-text entries 4 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 948 / CA
Registered: 2021-01-27

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

2020-12-29
Dose 1 — Moderna
2021-01-27
Registered in v-safe
2021-01-27
Dose 2 — Moderna
2021-01-27
Survey response — day 0, dose 2
MedDRA: Dizziness, Dysgeusia, Immediate post-injection reaction — Feeling: Fair · Site: Pain · Headache, Nausea

Free text: Metallic taste 15 min after vaccine. Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-02
Survey response — days 1–6 daily, dose 2
MedDRA: Rash — Feeling: Fair · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Rash on face and neck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — day 7, dose 2
Feeling: Fair · Chills, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-11
Survey response — day 14, dose 2
MedDRA: Chills, Lacrimation increased, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Poor · Be unable to work, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Chills with no fever, runny nose, watery eyes. I went and did a Covid test yesterday and it was negative.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Report sent to call center — day 14, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-24
Survey response — day 28, dose 2
MedDRA: Back pain — Feeling: Fair

Free text: Back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-28
Survey response — 6 months, dose 2
MedDRA: Abdominal pain, Fatigue, Formication, Hypoaesthesia, Mucous stools, Paraesthesia, Pruritus — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Abdominal pain, mucus in stool, severe fatigue, tingling/numbness in limbs, skin having a crawling feeling and itching

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-28
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-28
Call 1 — Could Not Reach Participant
2021-08-09
Call 1 — Left Voicemail
2021-11-05
Dose 3 — Moderna
2021-11-05
Survey response — day 0, dose 3
MedDRA: Headache, Migraine — Feeling: Fair · Headache

Free text: Migraine yesterday before booster shot today. Mild headache today

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Survey response — days 1–6 daily, dose 3
MedDRA: Erythema, Rash — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: My face is red, face and neck has a rash

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: Lacrimation increased, Ocular hyperaemia, Periorbital swelling, Rhinorrhoea — Feeling: Poor · Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Free text: Runny nose and watery eye with redness and puffy eye only on the left side"

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — day 7, dose 3
Feeling: Fair · None

Adult check-in
2021-11-19
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-29
Survey response — day 21, dose 3
MedDRA: Oropharyngeal pain — Feeling: Fair

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Survey response — day 28, dose 3
MedDRA: Fatigue — Feeling: Fair

Free text: Fatigue

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Survey response — day 35, dose 3
MedDRA: Cough, Hypoaesthesia, Lacrimation increased, Oropharyngeal pain, Pain, Rhinorrhoea, SARS-CoV-2 test — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Sore throat, cough, runny nose, watery eyes, body aches, fatigue, numbness in my back. Took a Covid test today, waiting for results

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — day 42, dose 3
MedDRA: Chest pain, Cough, Fatigue, Oropharyngeal pain, SARS-CoV-2 test negative — 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: Cough, burning in chest, sore throat, fatigue from last Friday to Tuesday. Symptoms better now. I did take a Covid test Friday and 2 rapid home tests on Sunday and Tuesday, they were all negative

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Report sent to call center — day 42, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-20
Call 1 — Left Voicemail
2022-02-04
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-06
Survey response — 6 months, dose 3
MedDRA: Abdominal pain upper, Blood alkaline phosphatase increased, Hepatic function abnormal — 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, Emergency room or emergency department visit

Free text: Upper abdominal pain for a few months, one episode of elevated liver function and alkaline phosphatase levels, possibly passed a stone in the common bile duct

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Report sent to call center — 6 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2022-05-09
Call 1 — Left Voicemail
2022-05-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-05
Health check-in — 12 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-29	Moderna
2	2021-01-27	Moderna
3	2021-11-05	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-11	Unsuccessful
2021-07-28	Unsuccessful
2021-12-17	Unsuccessful
2022-05-06	Successful 2022-05-09	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 2 — day 0, dose 2

2021-01-27

Systemic reaction (other): Metallic taste 15 min after vaccine. Dizziness

Release 3 — days 1–6 daily, dose 2

2021-02-02

Systemic reaction (other): Rash on face and neck

Release 4 — day 14, dose 2

2021-02-11

Symptoms: Chills with no fever, runny nose, watery eyes. I went and did a Covid test yesterday and it was negative.

Release 4 — day 28, dose 2

2021-02-24

Symptoms: Back pain

Release 9 — 6 months, dose 2

2021-07-28

Symptoms: Abdominal pain, mucus in stool, severe fatigue, tingling/numbness in limbs, skin having a crawling feeling and itching

Release 10 — day 0, dose 3

2021-11-05

Systemic reaction (other): Migraine yesterday before booster shot today. Mild headache today

Release 10 — days 1–6 daily, dose 3

2021-11-06

Systemic reaction (other): My face is red, face and neck has a rash

2021-11-11

Systemic reaction (other): Runny nose and watery eye with redness and puffy eye only on the left side"

Release 10 — day 21, dose 3

2021-11-29

Symptoms: Sore throat

Release 10 — day 28, dose 3

2021-12-03

Symptoms: Fatigue

Release 10 — day 35, dose 3

2021-12-10

Symptoms: Sore throat, cough, runny nose, watery eyes, body aches, fatigue, numbness in my back. Took a Covid test today, waiting for results

Release 10 — day 42, dose 3

2021-12-17

Symptoms: Cough, burning in chest, sore throat, fatigue from last Friday to Tuesday. Symptoms better now. I did take a Covid test Friday and 2 rapid home tests on Sunday and Tuesday, they were all negative

Release 11 — 6 months, dose 3

2022-05-06

Symptoms: Upper abdominal pain for a few months, one episode of elevated liver function and alkaline phosphatase levels, possibly passed a stone in the common bile duct

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	Abdominal pain	✓	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Back pain	✓	✓	✓
SD	Blood alkaline phosphatase increased	·	·	✓
SD	Chest pain	·	·	✓
SD	Chills	✓	✓	✓
SD	Cough	·	·	✓
SD	Fatigue	✓	·	✓
SD	Formication	✓	·	✓
SD	Hepatic function abnormal	·	·	✓
SD	Hypoaesthesia	✓	·	✓
SD	Lacrimation increased	✓	✓	✓
SD	Mucous stools	✓	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Paraesthesia	✓	·	✓
SD	Pruritus	✓	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	SARS-CoV-2 test	·	·	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Erythema	·	·	✓
SRO	Headache	·	·	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Lacrimation increased	·	·	✓
SRO	Migraine	·	·	✓
SRO	Ocular hyperaemia	·	·	✓
SRO	Periorbital swelling	·	·	✓
SRO	Rash	✓	✓	✓
SRO	Rhinorrhoea	·	·	✓

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