Z59-22495-84503

1 vaccination 11 coded responses 13 check-ins 11 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 894 / NV
Registered: 2021-01-09

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

Timeline

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

2021-01-08
Dose 1 — Moderna
2021-01-09
Registered in v-safe
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Headache, Fatigue or tiredness, Abdominal pain

Free text: IBS

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-12
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good · Fever · Nausea, Abdominal pain

Free text: Itching skin last few days no rash

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Hypersensitivity, Pyrexia — Feeling: Fair · Site: Itching · Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Low garage fever and allergy attack

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-14
Survey response — days 1–6 daily, dose 1
MedDRA: Appetite disorder, Flatulence, Increased appetite — Feeling: Good · Abdominal pain

Free text: Gas . Appetitive is increasing today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-22
Survey response — day 14, dose 1
MedDRA: Chest pain, Irritable bowel syndrome — Feeling: Fair

Free text: Off and on chest pain off and on Irritable bowel

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — day 21, dose 1
MedDRA: Oral herpes — Feeling: Good

Free text: Cold sores broke out this am

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — day 28, dose 1
MedDRA: Unevaluable event — Feeling: Good · Be unable to do your normal daily activities

Free text: Another break out cold sores and diarrhea and head ache yesterday not sure if its related to the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — day 35, dose 1
MedDRA: Abdominal discomfort, Pre-existing disease — Feeling: Fair

Free text: Upset stomach today . IBS

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — day 42, dose 1
MedDRA: Anosmia, Pre-existing disease — Feeling: Good

Free text: Noticed loss of smell the past few weeks not sure of related to vaccine or just allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Survey response — 3 months, dose 1
MedDRA: Facial pain, Paranasal sinus discomfort — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Check pressure pain maybe asthma allergies not sure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Report sent to call center — 3 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-09
Call 1 — Left Voicemail
2021-07-11
Survey response — 6 months, dose 1
MedDRA: Chest pain, Heart rate irregular, Pain in extremity — Feeling: Poor · 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

Free text: Chest pain irregular heart beat low energy leg pain arm pain

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

1 call case(s)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-08	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-13	priority 2/3
2021-04-09	Unsuccessful
2021-07-11	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-09

Systemic reaction (other): IBS

2021-01-12

Systemic reaction (other): Itching skin last few days no rash

2021-01-13

Systemic reaction (other): Low garage fever and allergy attack

Release 2 — days 1–6 daily, dose 1

2021-01-14

Systemic reaction (other): Gas . Appetitive is increasing today

Release 2 — day 14, dose 1

2021-01-22

Symptoms: Off and on chest pain off and on Irritable bowel

Release 3 — day 21, dose 1

2021-01-29

Symptoms: Cold sores broke out this am

Release 3 — day 28, dose 1

2021-02-06

Symptoms: Another break out cold sores and diarrhea and head ache yesterday not sure if its related to the shot

Release 4 — day 35, dose 1

2021-02-12

Symptoms: Upset stomach today . IBS

Release 4 — day 42, dose 1

2021-02-22

Symptoms: Noticed loss of smell the past few weeks not sure of related to vaccine or just allergies

Release 7 — 3 months, dose 1

2021-04-09

Symptoms: Check pressure pain maybe asthma allergies not sure

Release 9 — 6 months, dose 1

2021-07-11

Symptoms: Chest pain irregular heart beat low energy leg pain arm pain

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
SD	Abdominal discomfort	✓	✓	✓
SD	Anosmia	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Facial pain	✓	✓	✓
SD	Heart rate irregular	✓	✓	✓
SD	Irritable bowel syndrome	✓	✓	✓
SD	Oral herpes	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Paranasal sinus discomfort	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Unevaluable event	✓	✓	✓
SRO	Appetite disorder	✓	✓	○
SRO	Flatulence	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Increased appetite	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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