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Z4U-23320-22031

3 vaccinations 4 coded responses 17 check-ins 4 free-text entries 2 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
441 / OH
Registered
2021-01-30
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-27
    Dose 1 — Moderna
  2. 2021-01-30
    Registered in v-safe
  3. 2021-02-01
    Survey response — days 1–6 daily, dose 1
    MedDRA: Back pain, Unevaluable event — Feeling: Fair · Chills, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional
    Free text: Systemic reaction (other): Lower back pain · Healthcare visit (other): Rest, Tums, GingerAle, Crackers, Water
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-01
    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)
  5. 2021-02-02
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities
    Adult check-in
  6. 2021-02-03
    Health check-in — day 7, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  7. 2021-02-10
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  8. 2021-02-17
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  9. 2021-02-24
    Dose 2 — Moderna
  10. 2021-02-24
    Survey response — day 0, dose 2
    MedDRA: Epistaxis — Feeling: Poor · Chills, Joint pains, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities
    Free text: Bloody nose
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-02-25
    Survey response — days 1–6 daily, dose 2
    MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness
    Free text: None
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-02-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  13. 2021-03-01
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-03-02
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-03-03
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-03-10
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-03-19
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-03-24
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  19. 2021-03-31
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-04-09
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-06-14
  22. 2021-12-22
    Dose 3 — Moderna
  23. 2022-12-22
    Survey response — 12 months, dose 3
    MedDRA: Adverse drug reaction, Atrial fibrillation, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization
    Free text: Symptoms: Since getting the 3rd shot 12/22/2021 my heart goes into afib at least once a day. That started less than 24 hrs after getting the 3rd shot. NO MORE SHOTS for me!! Sorry I received all 3 now. · Healthcare visit (other): Plus in office visit with Cardiologist and also a surgeon to see about alternative procedures since I have reactions to almost all the meds including baby aspirin, asparin, and blood thinners.
    MedDRA releases: 2024-11 · check-in free text available
  24. 2022-12-22
    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
    Hospitalization · 1 call case(s)
  25. 2022-12-23
  26. 2022-12-23

Vaccinations

DoseDateManufacturerCo-administered
12021-01-27Moderna
22021-02-24Moderna
32021-12-22Moderna No

Call center

ReportedOutcomeVAERS-related outcome
2021-02-01 Unsuccessful Reported to VAERS voluntarily prior to GDIT contact
2022-12-22 Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-01

Systemic reaction (other): Lower back pain
Healthcare visit (other): Rest, Tums, GingerAle, Crackers, Water

Release 4 — day 0, dose 2

2021-02-24

Systemic reaction (other): Bloody nose

Release 4 — days 1–6 daily, dose 2

2021-02-25

Systemic reaction (other): None

Release 12 — 12 months, dose 3

2022-12-22

Symptoms: Since getting the 3rd shot 12/22/2021 my heart goes into afib at least once a day. That started less than 24 hrs after getting the 3rd shot. NO MORE SHOTS for me!! Sorry I received all 3 now.
Healthcare visit (other): Plus in office visit with Cardiologist and also a surgeon to see about alternative procedures since I have reactions to almost all the meds including baby aspirin, asparin, and blood thinners.

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

FieldPreferred term2021-092023-042024-11
HCVOAdverse drug reaction · · ✓
HCVOOffice visit · · ✓
HCVOUnevaluable event ✓ ✓ ✓
SDAtrial fibrillation · · ✓
SROBack pain ✓ ✓ ✓
SROEpistaxis ✓ ✓ ✓
SRONo adverse event ✓ ✓ ✓

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

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