Z47-17257-58596

3 vaccinations 5 coded responses 35 check-ins 5 free-text entries 1 call case

Sex: Female
Age at first dose: 31-35
ZIP prefix: 546 / WI
Registered: 2021-03-18

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

Registered dependents

HCR-30340-60782 Child or adolescent in my care · Male · 2021-11-14

XC6-24002-68096 Child or adolescent in my care · Male · 2022-02-20

Timeline

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

2021-03-17
Dose 1 — Moderna
2021-03-18
Registered in v-safe
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Chills, Headache, Muscle or body aches

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 7, dose 1
Feeling: Good · Headache · Be unable to work

Adult check-in
2021-03-31
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-07
Survey response — day 21, dose 1
MedDRA: Migraine — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Frequent migraines

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Dose 2 — Moderna
2021-04-14
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Nausea

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-21
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-30
Survey response — day 14, dose 2
MedDRA: Anxiety, Fatigue, Headache, Nausea, Unevaluable event — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Worsening depression and mood changes. Anxiety worse. Head pressure/face pressure. Jaw pain. Lots of fatigue and exhaustion completing tasks. Heart rate spikes. Tinnitus in ear. Nausea. Eye pain/dry eyes and blurry vision. · Healthcare visit (other): May consider talking to doctor soon

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Report sent to call center — day 14, 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)
2021-05-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-13
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-06
Dose 3 — Moderna
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Eye pain, Rhinorrhoea, Sinus pain — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Sore eyes, sinus pain, runny nose

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-12
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-13
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-22
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-04
Survey response — day 28, dose 3
MedDRA: Asthenopia, Dry eye, Erythema, Fatigue, Pruritus — Feeling: Good

Free text: Itchy skin/redness. More tired than usual. Tired eyes. Dry eyes.

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
Survey response — day 42, dose 3
MedDRA: Fatigue, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Worsening fatigue than normal.

MedDRA releases: 2024-11 · check-in free text available
2022-02-05
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-14
Call 1 — Left Voicemail
2022-05-07
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-06
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Moderna
2	2021-04-14	Moderna
3	2021-11-06	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-30	Unsuccessful

Free text

Release 7 — day 21, dose 1

2021-04-07

Symptoms: Frequent migraines

Release 8 — day 14, dose 2

2021-04-30

Symptoms: Worsening depression and mood changes. Anxiety worse. Head pressure/face pressure. Jaw pain. Lots of fatigue and exhaustion completing tasks. Heart rate spikes. Tinnitus in ear. Nausea. Eye pain/dry eyes and blurry vision.

Healthcare visit (other): May consider talking to doctor soon

Release 10 — days 1–6 daily, dose 3

2021-11-07

Systemic reaction (other): Sore eyes, sinus pain, runny nose

Release 10 — day 28, dose 3

2021-12-04

Symptoms: Itchy skin/redness. More tired than usual. Tired eyes. Dry eyes.

Release 10 — day 42, dose 3

2021-12-18

Symptoms: Worsening fatigue than normal.

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	Unevaluable event	✓	✓	✓
SD	Anxiety	✓	✓	✓
SD	Asthenopia	·	·	✓
SD	Dry eye	·	·	✓
SD	Erythema	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	·	·	✓
SRO	Eye pain	·	·	✓
SRO	Rhinorrhoea	·	·	✓
SRO	Sinus pain	·	·	✓

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