Z5T-21121-64535

4 vaccinations 10 coded responses 40 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 631 / MO
Registered: 2021-02-11

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

Timeline

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

2021-02-10
Dose 1 — Moderna
2021-02-11
Registered in v-safe
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-24
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-03-10
Dose 2 — Moderna
2021-03-10
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Nasopharyngitis — Feeling: Fair · Site: Redness · Chills, Joint pains

Free text: No fever but soooo cold off and on.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Visual impairment — Feeling: Good

Free text: Everything looks gray and a little dilapidated.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-17
Survey response — day 7, dose 2
MedDRA: Musculoskeletal pain, Pain in extremity — Feeling: Good · Muscle or body aches

Free text: Pain in legs and buttocks

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-09
Survey response — 3 months, dose 2
MedDRA: Diarrhoea, Nausea — Feeling: Good · Be unable to do your normal daily activities

Free text: Nausea, diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-08
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness · Muscle or body aches

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Survey response — 3 months, dose 3
MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities

Free text: I have had a severe cold for three weeks. Tested negative for covid twice in that period as did my husband. Am now prepping for a colonoscopy. Cold is resolved.

MedDRA releases: 2024-11 · check-in free text available
2022-04-07
Dose 4 — Moderna
2022-04-19
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-04-24
Survey response — day 14, dose 4
MedDRA: Fatigue, Nasopharyngitis, Rhinorrhoea, SARS-CoV-2 test negative, Sneezing — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Terrible cold, sneezing, drippy nose, fatigue. Covid test negative.

MedDRA releases: 2024-11 · check-in free text available
2022-04-28
Health check-in — day 21, dose 4
Feeling: Good

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

Adult check-in
2022-05-14
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-19
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-08
Survey response — 3 months, dose 4
MedDRA: Fatigue, Feeling hot, Headache, Oropharyngeal pain, Pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headache, fatigue, sore throat, feeling hot though not feverish, achy

MedDRA releases: 2024-11 · check-in free text available
2022-10-08
Survey response — 6 months, dose 4
MedDRA: COVID-19, 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

Free text: Symptoms: Covid19 · Healthcare visit (other): Daughter, Dr. (b)(6)

MedDRA releases: 2024-11 · check-in free text available
2022-10-08
Report sent to call center — 6 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

1 call case(s)
2022-10-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-07
Survey response — 12 months, dose 4
MedDRA: Fatigue, Nasal congestion, Sinus congestion — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-10	Moderna
2	2021-03-10	Moderna
3	2021-10-25	Moderna	No
4	2022-04-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-10-08	Successful 2022-10-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-11

Systemic reaction (other): Dizziness

2021-03-12

Systemic reaction (other): No fever but soooo cold off and on.

2021-03-15

Systemic reaction (other): Everything looks gray and a little dilapidated.

Release 5 — day 7, dose 2

2021-03-17

Systemic reaction (other): Pain in legs and buttocks

Release 9 — 3 months, dose 2

2021-06-09

Symptoms: Nausea, diarrhea

Release 11 — 3 months, dose 3

2022-01-24

Symptoms: I have had a severe cold for three weeks. Tested negative for covid twice in that period as did my husband. Am now prepping for a colonoscopy. Cold is resolved.

Release 11 — day 14, dose 4

2022-04-24

Symptoms: Terrible cold, sneezing, drippy nose, fatigue. Covid test negative.

Release 12 — 3 months, dose 4

2022-07-08

Symptoms: Headache, fatigue, sore throat, feeling hot though not feverish, achy

Release 12 — 6 months, dose 4

2022-10-08

Symptoms: Covid19

Healthcare visit (other): Daughter, Dr. (b)(6)

redacted (b)(6)

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	Unevaluable event	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Feeling hot	·	·	✓
SD	Headache	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sneezing	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Musculoskeletal pain	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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