Z4R-15584-33950

2 vaccinations 13 coded responses 21 check-ins 13 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 786 / TX
Registered: 2021-03-01

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

2021-03-01
Registered in v-safe
2021-03-01
Dose 1 — Moderna
2021-03-01
Survey response — day 0, dose 1
MedDRA: Migraine — Feeling: Good · Headache

Free text: Migrainenot related to shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache

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

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain — Feeling: Good · Muscle or body aches, Fatigue or tiredness

Free text: Chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Unevaluable event — Feeling: Good · Site: Pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Chest pain continuing on right side. I dont know if its related to injection. · Healthcare visit (other): Scheduled for March 10.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-08
Survey response — day 7, dose 1
MedDRA: Chest pain — Feeling: Good · Fatigue or tiredness

Free text: Chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-22
Survey response — day 21, dose 1
MedDRA: Chest pain, Musculoskeletal pain, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Chest pain and in my back under right shoulder blade. · Healthcare visit (other): Have scheduled FU with cardiologist.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-29
Dose 2 — Moderna
2021-03-29
Survey response — day 0, dose 2
MedDRA: Tachycardia — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness

Free text: Tachycardia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain, Livedo reticularis — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mottled skin in upper arm, some chest pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Free text: My temp is down from 98.8 to my normal 97.2, but chest pain a little worse than yesterday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Adult check-in
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Moderate chest pain even tho I take Jantoven and Imdur.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Headache, Muscle or body aches

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-05
Survey response — day 7, dose 2
MedDRA: Chest pain — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Less chest pain finally.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-28
Survey response — 3 months, dose 2
MedDRA: Contusion, Fatigue — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: A little more fatigue; more bruising since I take blood thinners.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-28
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-02
Call 1 — Left Voicemail
2021-09-27
Survey response — 6 months, dose 2
MedDRA: Office visit, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: I may have a perforation of my IVC filter. · Healthcare visit (other): My urologist spotted the condition. Am in contact with cardiologist.

MedDRA releases: 2024-11 · check-in free text available
2021-09-27
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-30
Call 1 — Left Voicemail
2022-03-29
Survey response — 12 months, dose 2
MedDRA: Gastrointestinal haemorrhage — Feeling: Fair · Be unable to do your normal daily activities

Free text: Occasional brief GI bleeds.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-01	Moderna
2	2021-03-29	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-07	Unsuccessful
2021-03-22	Unsuccessful
2021-06-28	Unsuccessful
2021-09-27	Unsuccessful

Free text

Release 4 — day 0, dose 1

2021-03-01

Systemic reaction (other): Migrainenot related to shot.

Release 5 — days 1–6 daily, dose 1

2021-03-06

Systemic reaction (other): Chest pain

2021-03-07

Systemic reaction (other): Chest pain continuing on right side. I dont know if its related to injection.

Healthcare visit (other): Scheduled for March 10.

Release 5 — day 7, dose 1

2021-03-08

Systemic reaction (other): Chest pain

Release 6 — day 21, dose 1

2021-03-22

Symptoms: Chest pain and in my back under right shoulder blade.

Healthcare visit (other): Have scheduled FU with cardiologist.

Release 6 — day 0, dose 2

2021-03-29

Systemic reaction (other): Tachycardia

Release 6 — days 1–6 daily, dose 2

2021-03-30

Systemic reaction (other): Mottled skin in upper arm, some chest pain.

2021-03-31

Systemic reaction (other): My temp is down from 98.8 to my normal 97.2, but chest pain a little worse than yesterday.

2021-04-02

Systemic reaction (other): Moderate chest pain even tho I take Jantoven and Imdur.

Release 6 — day 7, dose 2

2021-04-05

Systemic reaction (other): Less chest pain finally.

Release 9 — 3 months, dose 2

2021-06-28

Symptoms: A little more fatigue; more bruising since I take blood thinners.

Release 9 — 6 months, dose 2

2021-09-27

Symptoms: I may have a perforation of my IVC filter.

Healthcare visit (other): My urologist spotted the condition. Am in contact with cardiologist.

Release 11 — 12 months, dose 2

2022-03-29

Symptoms: Occasional brief GI bleeds.

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	·	·	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Contusion	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal haemorrhage	·	·	✓
SD	Musculoskeletal pain	✓	✓	✓
SD	Unevaluable event	·	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Livedo reticularis	✓	✓	✓
SRO	Migraine	✓	✓	✓
SRO	Tachycardia	✓	✓	✓

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