Z5B-21517-37498
5 vaccinations
10 coded responses
62 check-ins
9 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 300 / GA
- Registered
- 2021-01-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-11
Registered in v-safe
-
2021-01-11
Dose 1 — Moderna
-
2021-01-11
Health check-in — day 0, dose 1Feeling: Good · Chills, Headache, Fatigue or tiredness, NauseaAdult check-in
-
2021-01-12
Survey response — days 1–6 daily, dose 1MedDRA: Pain in extremity — Feeling: GoodFree text: Arm just a little sore.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-13
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
-
2021-01-18
Survey response — day 7, dose 1MedDRA: Adverse reaction, Unevaluable event — Feeling: Good · Headache, NauseaFree text: These marked above I felt last night after I turned in this survey but it went away and I feel fine today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-25
- 2021-02-01
-
2021-02-08
Dose 2 — Moderna
- 2021-02-08
-
2021-02-09
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal painAdult check-in
-
2021-02-10
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal painAdult check-in
-
2021-02-11
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-02-12
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Swelling, Itching · Fever · Fatigue or tiredness, DiarrheaAdult check-in
-
2021-02-13
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Swelling, Itching · Fatigue or tirednessAdult check-in
- 2021-02-14
- 2021-02-15
- 2021-02-22
-
2021-03-01
Survey response — day 21, dose 2MedDRA: Abdominal pain lower — Feeling: GoodFree text: Lower abdominal crampsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-09
- 2021-03-16
-
2021-03-22
Survey response — day 42, dose 2MedDRA: Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Dislocated my shoulder, went to ER, nothing virus related.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-22
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-10
-
2021-08-09
Survey response — 6 months, dose 2MedDRA: Emergency care, Joint dislocation, Nerve injury, Physiotherapy, Rotator cuff syndrome, Surgery — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Dislocated shoulder, tore rotator cuff and auxiliary nerve damage. Have had surgery · Healthcare visit (other): Surgery after ER as an outpatient. Have been going to PT since March 2021MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-09
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-12
-
2021-08-23
Dose 3 — ModernaCo-administered: Flu
-
2021-08-25
Survey response — days 1–6 daily, dose 3MedDRA: Body temperature increased, Pain — Feeling: Good · Site: Pain · Muscle or body aches, DiarrheaFree text: Ran 99.9 fever yesterday with aches and pains. Fever gone, still have some aches.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-26
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
-
2021-08-27
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Itching · Fatigue or tiredness, DiarrheaAdult check-in
-
2021-08-28
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — Feeling: Good · Site: Itching · FeverFree text: Normally my temperature is 97°MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-29
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Itching · Fatigue or tiredness, DiarrheaAdult check-in
- 2021-08-30
- 2021-09-06
- 2021-09-13
- 2021-09-20
- 2021-09-27
- 2021-10-04
- 2021-11-22
- 2022-02-21
-
2022-03-30
Dose 4 — Moderna
-
2022-04-01
Survey response — days 1–6 daily, dose 4MedDRA: Chills, Pyrexia — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: Fever day 1, 99.3, fever day 2 100.9 all other doses was reaction only day 2, low fever. This was the first time I had a reaction six hours from the shot. Chills all the rest of the time until the fever sometime in the middle of the night.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-02
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Abdominal painAdult check-in
- 2022-04-03
- 2022-04-04
- 2022-04-05
- 2022-04-06
- 2022-04-13
- 2022-04-20
- 2022-04-28
- 2022-05-04
- 2022-05-11
- 2022-06-29
-
2022-09-12
Dose 5 — Moderna
- 2022-09-12
-
2022-09-16
Survey response — days 1–6 daily, dose 5MedDRA: Pyrexia — Feeling: Fair · Site: Pain, Redness, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal painFree text: These symptoms are from first and second day. Fever came on within 4 hours. Second day same way. Gone by day three. All prior vaccines, was feeling fine until night of day 2.MedDRA releases: 2024-11 · check-in free text available
- 2022-09-17
- 2022-09-18
- 2022-09-19
- 2022-09-26
- 2022-10-03
- 2022-10-10
- 2022-10-17
- 2022-10-24
- 2022-12-12
-
2023-03-13
Survey response — 6 months, dose 5MedDRA: Office visit, Rales, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
-
2023-03-13
Report sent to call center — 6 months, dose 5Get care from a doctor or other healthcare professional1 call case(s)
- 2023-03-14
- 2023-03-14
- 2023-03-14
-
2023-03-15
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-03-15
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-03-15
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-08 | Moderna | |
| 3 | 2021-08-23 | Moderna | Flu |
| 4 | 2022-03-30 | Moderna | No |
| 5 | 2022-09-12 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-22 | Successful 2023-03-15 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2021-08-09 | Successful 2023-03-15 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-03-13 | Successful 2023-03-15 |
Participant prefers to complete VAERS report online |
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Arm just a little sore.
Release 2 — day 7, dose 1
Systemic reaction (other): These marked above I felt last night after I turned in this survey but it went away and I feel fine today.
Release 4 — day 21, dose 2
Symptoms: Lower abdominal cramps
Release 6 — day 42, dose 2
Symptoms: Dislocated my shoulder, went to ER, nothing virus related.
Release 9 — 6 months, dose 2
Symptoms: Dislocated shoulder, tore rotator cuff and auxiliary nerve damage. Have had surgery
Healthcare visit (other): Surgery after ER as an outpatient. Have been going to PT since March 2021
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): Ran 99.9 fever yesterday with aches and pains. Fever gone, still have some aches.
Systemic reaction (other): Normally my temperature is 97°
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Fever day 1, 99.3, fever day 2 100.9 all other doses was reaction only day 2, low fever. This was the first time I had a reaction six hours from the shot. Chills all the rest of the time until the fever sometime in the middle of the night.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): These symptoms are from first and second day. Fever came on within 4 hours. Second day same way. Gone by day three. All prior vaccines, was feeling fine until night of day 2.
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 | Emergency care | ✓ | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| HCVO | Physiotherapy | ✓ | · | ✓ |
| HCVO | Surgery | ✓ | · | ✓ |
| SD | Abdominal pain lower | ✓ | ✓ | ✓ |
| SD | Joint dislocation | ✓ | · | ✓ |
| SD | Nerve injury | ✓ | · | ✓ |
| SD | Rales | · | · | ✓ |
| SD | Rotator cuff syndrome | ✓ | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Surgery | ✓ | · | ✓ |
| SD | Unevaluable event | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | ✓ | · | ✓ |
| SRO | Body temperature increased | ✓ | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Pain | ✓ | · | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Pyrexia | · | · | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release