Z53-17745-10864

3 vaccinations 6 coded responses 34 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 781 / TX
Registered: 2021-03-06

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-03-06
Registered in v-safe
2021-03-06
Dose 1 — Moderna
2021-03-06
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-03
Dose 2 — Moderna
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-08
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
2021-04-09
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
2021-04-10
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-17
Survey response — day 14, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tiredness and Fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-15
Survey response — day 42, dose 2
MedDRA: Glucose tolerance impaired, Insulin resistance — Feeling: Good

Free text: Pre-diabetes, insulin resistance

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-02
Survey response — 6 months, dose 2
MedDRA: Cough, Decreased appetite, Fatigue, Headache, Nasal congestion, Pyrexia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Cough, nasal congestion, headache, mild fever, fatigue, and decreased appetite. But i think it was because i had received a flu shot before I got sick. But everything is better now.

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Dose 3 — Moderna
2021-12-26
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-12-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-12-31
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-01-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-01-02
Health check-in — day 7, dose 3
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-01-09
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2022-01-16
Survey response — day 21, dose 3
MedDRA: Gastrointestinal haemorrhage, Haematochezia, Haemoglobin decreased, Unevaluable event, Vomiting — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: GI bleeding, vomiting, defecating blood, and very low hemoglobin. · Healthcare visit (other): with endoscopy procedure.

MedDRA releases: 2024-11 · check-in free text available
2022-01-16
Report sent to call center — day 21, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-01-17
Call 1 — Left Voicemail
2022-01-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-31
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-27
Survey response — 3 months, dose 3
MedDRA: Gastric ulcer, Gastrointestinal haemorrhage, Hospitalisation, Transfusion — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: GI Bleed from a stomach ulcer, treated with a blood transfusion. · Healthcare visit (other): Admitted

MedDRA releases: 2024-11 · check-in free text available
2022-03-27
Report sent to call center — 3 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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-30
Call 1 — Left Voicemail
2022-06-26
Survey response — 6 months, dose 3
MedDRA: Bronchitis, Pyrexia — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Bronchitis with fever.

MedDRA releases: 2024-11 · check-in free text available
2022-06-26
Report sent to call center — 6 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)
2022-06-28
Call 2 — Left Voicemail
2022-06-28
Call 2 — Left Voicemail
2022-06-28
Call 1 — Left Voicemail
2022-12-26
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-06	Moderna
2	2021-04-03	Moderna
3	2021-12-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-16	Unsuccessful
2022-03-27	Unsuccessful
2022-06-26	Unsuccessful

Free text

Release 7 — day 14, dose 2

2021-04-17

Symptoms: Tiredness and Fatigue

Release 8 — day 42, dose 2

2021-05-15

Symptoms: Pre-diabetes, insulin resistance

Release 9 — 6 months, dose 2

2021-10-02

Symptoms: Cough, nasal congestion, headache, mild fever, fatigue, and decreased appetite. But i think it was because i had received a flu shot before I got sick. But everything is better now.

Release 10 — day 21, dose 3

2022-01-16

Symptoms: GI bleeding, vomiting, defecating blood, and very low hemoglobin.

Healthcare visit (other): with endoscopy procedure.

Release 11 — 3 months, dose 3

2022-03-27

Symptoms: GI Bleed from a stomach ulcer, treated with a blood transfusion.

Healthcare visit (other): Admitted

Release 12 — 6 months, dose 3

2022-06-26

Symptoms: Bronchitis with fever.

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	Hospitalisation	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	Bronchitis	·	·	✓
SD	Cough	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gastric ulcer	·	·	✓
SD	Gastrointestinal haemorrhage	·	·	✓
SD	Glucose tolerance impaired	✓	✓	✓
SD	Haematochezia	·	·	✓
SD	Haemoglobin decreased	·	·	✓
SD	Headache	·	·	✓
SD	Insulin resistance	✓	✓	✓
SD	Nasal congestion	·	·	✓
SD	Pyrexia	·	·	✓
SD	Transfusion	·	·	✓
SD	Vomiting	·	·	✓

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