Z5T-16736-63809

5 vaccinations 10 coded responses 23 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 100 / NY
Registered: 2021-02-15

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Timeline

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

2021-02-13
Dose 1 — Moderna
2021-02-15
Registered in v-safe
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Redness · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Muscle spasms — Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness

Free text: Left foot and hand contractions

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: Blepharospasm, Extremity contracture, Eyelid function disorder, Muscle spasms — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Contractions of my left eye , left hand and foot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 1
MedDRA: Muscle contractions involuntary, Muscle fatigue — Feeling: Fair · Site: Redness, Swelling · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Contractions on left foot and left hand , fatigued left side

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Site: Redness · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Short of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — day 7, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Fatigue or tiredness

Free text: SOB

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-25
Dose 2 — Moderna
2021-05-15
Survey response — 3 months, dose 1
MedDRA: Migraine — Feeling: Fair

Free text: Migraine headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-16
Health check-in — 6 months, dose 1
Feeling: Good

Adult check-in
2021-11-11
Dose 3 — Moderna
2022-02-13
Health check-in — 12 months, dose 1
Feeling: Good

Adult check-in
2022-04-24
Dose 4 — Moderna
2022-05-14
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-19
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-22
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-05
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-24
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-03
Dose 5 — Moderna
2022-10-23
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2022-10-23
Survey response — day 14, dose 5
MedDRA: Ear discomfort, Nasopharyngitis, Pre-existing disease, Sinusitis — Feeling: Good

Free text: After my last booster on 10/3/2022 I developed a head cold that lasted about 10 days . I had a nasal cavity infection and given antibiotics. I felt a lot of pressure inside my ears . I took asthma meds to prevent asthma

MedDRA releases: 2024-11 · check-in free text available
2022-10-31
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-07
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-14
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-02
Survey response — 3 months, dose 5
MedDRA: Abdominal pain, Influenza virus test negative, Office visit, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-02
Report sent to call center — 3 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-01-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-03
Survey response — 6 months, dose 5
MedDRA: Cough, Nasopharyngitis, Office visit, Secretion discharge, Upper respiratory tract inflammation — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-03
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-04
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-25	Moderna	No
3	2021-11-11	Moderna	No
4	2022-04-24	Moderna	No
5	2022-10-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2023-01-02	Successful 2023-01-03	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-03	Successful 2023-04-04	Does not wish to fill out VAERS report

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-15

Systemic reaction (other): Lightheaded

2021-02-16

Systemic reaction (other): Left foot and hand contractions

2021-02-17

Systemic reaction (other): Contractions of my left eye , left hand and foot

2021-02-18

Systemic reaction (other): Contractions on left foot and left hand , fatigued left side

2021-02-19

Systemic reaction (other): Short of breath

Release 4 — day 7, dose 1

2021-02-21

Systemic reaction (other): SOB

Release 8 — 3 months, dose 1

2021-05-15

Symptoms: Migraine headaches

Release 12 — day 14, dose 5

2022-10-23

Symptoms: After my last booster on 10/3/2022 I developed a head cold that lasted about 10 days . I had a nasal cavity infection and given antibiotics. I felt a lot of pressure inside my ears . I took asthma meds to prevent asthma

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	Office visit	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Cough	·	·	✓
SD	Ear discomfort	·	·	✓
SD	Influenza virus test negative	·	·	✓
SD	Migraine	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Office visit	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Secretion discharge	·	·	✓
SD	Sinusitis	·	·	✓
SD	Upper respiratory tract inflammation	·	·	✓
SRO	Blepharospasm	✓	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Extremity contracture	○	✓	○
SRO	Eyelid function disorder	○	✓	○
SRO	Muscle contractions involuntary	✓	✓	✓
SRO	Muscle fatigue	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓

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