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Z56-27917-57874

4 vaccinations 10 coded responses 48 check-ins 9 free-text entries 1 call case
Sex
Female
Age at first dose
66+
ZIP prefix
921 / CA
Registered
2021-01-27
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-27
    Registered in v-safe
  2. 2021-01-27
    Dose 1 — Moderna
  3. 2021-01-27
    Health check-in — day 0, dose 1
    Feeling: Good · None
    Adult check-in
  4. 2021-01-28
    Survey response — days 1–6 daily, dose 1
    MedDRA: Upper-airway cough syndrome — Feeling: Good
    Free text: A little post nasal drip
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-01-29
    Survey response — days 1–6 daily, dose 1
    MedDRA: Paranasal sinus hypersecretion — Feeling: Good · Headache
    Free text: Nasal drainage
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-30
    Survey response — days 1–6 daily, dose 1
    MedDRA: Drainage — Feeling: Good
    Free text: Nasal drainage
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-01-31
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-02-01
    Survey response — days 1–6 daily, dose 1
    MedDRA: Paranasal sinus hypersecretion — Feeling: Fair · Headache
    Free text: Nasal drainage
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-02-02
    Survey response — days 1–6 daily, dose 1
    MedDRA: Rhinorrhoea — Feeling: Good
    Free text: Nasal drainage
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-02-03
    Survey response — day 7, dose 1
    MedDRA: Upper-airway cough syndrome — Feeling: Good · Headache
    Free text: Nasal drainage
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-02-10
    Survey response — day 14, dose 1
    MedDRA: Headache — Feeling: Good · Be unable to do your normal daily activities
    Free text: Major headache all day yesterday starting above my right eye next to the bridge of my nose.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-02-17
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-02-24
    Health check-in — day 28, dose 1
    Feeling: Good
    Adult check-in
  14. 2021-02-25
    Dose 2 — Moderna
  15. 2021-02-25
    Health check-in — day 0, dose 2
    Feeling: Good · Site: Pain · Fatigue or tiredness
    Adult check-in
  16. 2021-02-26
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · Fatigue or tiredness
    Adult check-in
  17. 2021-02-27
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · None
    Adult check-in
  18. 2021-02-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · None
    Adult check-in
  19. 2021-03-01
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · Fatigue or tiredness
    Adult check-in
  20. 2021-03-02
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-03-03
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  22. 2021-03-04
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  23. 2021-03-11
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-03-18
    Survey response — day 21, dose 2
    MedDRA: Migraine — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Very bad migraines on Sunday, 3/14; Wednesday, 3/17, and Thursday, 3/18.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  25. 2021-03-25
    Survey response — day 28, dose 2
    MedDRA: Migraine, Self-medication — Feeling: Good · Be unable to do your normal daily activities
    Free text: Terrible migraines...4 in the last 10 days (3/14, 3/17-3/18, and 3/23). Tylenol would not work to ease it. My Butalbital (Fioricet) barely worked. They lasted all day long. I couldnt hardly sleep at all the night of 3/17.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  26. 2021-04-01
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-04-08
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-05-27
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  29. 2021-08-26
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  30. 2021-10-25
    Dose 3 — Moderna
    Co-administered: Flu
  31. 2021-10-25
    Health check-in — day 0, dose 3
    Feeling: Good · None
    Adult check-in
  32. 2021-10-26
    Health check-in — days 1–6 daily, dose 3
    Feeling: Poor · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  33. 2021-10-27
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · None
    Adult check-in
  34. 2021-10-28
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · None
    Adult check-in
  35. 2021-10-29
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · None
    Adult check-in
  36. 2021-10-30
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Pain · None
    Adult check-in
  37. 2021-10-31
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  38. 2021-11-01
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  39. 2021-11-08
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  40. 2021-11-15
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  41. 2021-11-22
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  42. 2021-11-29
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  43. 2021-12-06
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  44. 2022-01-24
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  45. 2022-03-31
    Dose 4 — Moderna
  46. 2022-04-14
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  47. 2022-04-21
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  48. 2022-04-28
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  49. 2022-05-05
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  50. 2022-05-12
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  51. 2022-06-30
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in
  52. 2022-09-29
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  53. 2023-04-02
    Survey response — 12 months, dose 4
    MedDRA: Nasopharyngitis, SARS-CoV-2 test negative, Sinus disorder, Unevaluable event — 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 · Outpatient clinic or urgent care clinic visit
    MedDRA releases: 2024-11
  54. 2023-04-02
    Report sent to call center — 12 months, dose 4
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  55. 2023-04-03
    Call successful
    Completed over the phone

Vaccinations

DoseDateManufacturerCo-administered
12021-01-27Moderna
22021-02-25Moderna
32021-10-25Moderna Flu
42022-03-31Moderna No

Call center

ReportedOutcomeVAERS-related outcome
2023-04-02 Successful
2023-04-03
 Completed over the phone

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-28

Systemic reaction (other): A little post nasal drip

Release 3 — days 1–6 daily, dose 1

2021-01-29

Systemic reaction (other): Nasal drainage

2021-01-30

Systemic reaction (other): Nasal drainage

2021-02-01

Systemic reaction (other): Nasal drainage

2021-02-02

Systemic reaction (other): Nasal drainage

Release 3 — day 7, dose 1

2021-02-03

Systemic reaction (other): Nasal drainage

Release 4 — day 14, dose 1

2021-02-10

Symptoms: Major headache all day yesterday starting above my right eye next to the bridge of my nose.

Release 5 — day 21, dose 2

2021-03-18

Symptoms: Very bad migraines on Sunday, 3/14; Wednesday, 3/17, and Thursday, 3/18.

Release 6 — day 28, dose 2

2021-03-25

Symptoms: Terrible migraines...4 in the last 10 days (3/14, 3/17-3/18, and 3/23). Tylenol would not work to ease it. My Butalbital (Fioricet) barely worked. They lasted all day long. I couldnt hardly sleep at all the night of 3/17.

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
SDHeadache ✓ ✓ ✓
SDMigraine ✓ ✓ ✓
SDNasopharyngitis · · ✓
SDSARS-CoV-2 test negative · · ✓
SDSelf-medication ✓ ✓ ✓
SDSinus disorder · · ✓
SDUnevaluable event · · ✓
SRODrainage ✓ ✓ ✓
SROParanasal sinus hypersecretion ✓ ✓ ✓
SRORhinorrhoea ✓ ✓ ✓
SROUpper-airway cough syndrome ✓ ✓ ✓

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

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