Z64-30431-43071

2 vaccinations 11 coded responses 19 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 211 / MD
Registered: 2021-05-28

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

2021-05-26
Dose 1 — Moderna
2021-05-28
Registered in v-safe
2021-05-28
Survey response — days 1–6 daily, dose 1
MedDRA: Chest discomfort, Cough — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Chest tight, cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Cough — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Cough chest hurt

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-30
Survey response — days 1–6 daily, dose 1
MedDRA: Rhinorrhoea — Feeling: Fair · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-06-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-06-02
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-06-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-06-16
Survey response — day 21, dose 1
MedDRA: Fatigue, Feeling of body temperature change, Headache, Pain in extremity, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: For days I am Feverish hot cold Arm pain headaxheTired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-23
Dose 2 — Moderna
2021-06-24
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Oropharyngeal pain, Tongue disorder, Visual impairment — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Vision a little off, tongue feels fatter, ear throat hurt a lil

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-25
Survey response — days 1–6 daily, dose 2
MedDRA: Dysphagia, Ear disorder, Pharyngeal disorder — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Ear and throar swallowing is harder

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-27
Survey response — days 1–6 daily, dose 2
MedDRA: Dry mouth, Paraesthesia oral — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Tongue feels fat and dry mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-28
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Rash erythematous, Vision blurred — Feeling: Good · Site: Pain · Headache, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Blurry vision red checks and rash

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-29
Survey response — days 1–6 daily, dose 2
MedDRA: Rash, Scab — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Rash on checks turn scabs heeling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-30
Health check-in — day 7, dose 2
Feeling: Good · Headache, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-07-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-07-21
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-07-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-08-05
Survey response — day 42, dose 2
MedDRA: Arthralgia, Chest pain, Chills, Cough, Ear pain, Feeling of body temperature change, Headache, Insomnia, Pain in extremity, Pain in jaw, Rhinorrhoea — Feeling: Poor · Be unable to work or attend school

Free text: Headache, runny nose. Ear jaw chest hurt, cough arms ache, chills, hot and then freezing, no sleep,shoulder joints hurt

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-22
Survey response — 3 months, dose 2
MedDRA: COVID-19 — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Covid positive

MedDRA releases: 2024-11 · check-in free text available
2021-09-22
Report sent to call center — 3 months, dose 2
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)
2021-09-24
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-26	Moderna
2	2021-06-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-22	Unsuccessful

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-28

Systemic reaction (other): Chest tight, cough

2021-05-29

Systemic reaction (other): Cough chest hurt

2021-05-30

Systemic reaction (other): Runny nose

Release 9 — day 21, dose 1

2021-06-16

Symptoms: For days I am Feverish hot cold Arm pain headaxheTired

Release 9 — days 1–6 daily, dose 2

2021-06-24

Systemic reaction (other): Vision a little off, tongue feels fatter, ear throat hurt a lil

2021-06-25

Systemic reaction (other): Ear and throar swallowing is harder

2021-06-27

Systemic reaction (other): Tongue feels fat and dry mouth

2021-06-28

Systemic reaction (other): Blurry vision red checks and rash

2021-06-29

Systemic reaction (other): Rash on checks turn scabs heeling

Release 9 — day 42, dose 2

2021-08-05

Symptoms: Headache, runny nose. Ear jaw chest hurt, cough arms ache, chills, hot and then freezing, no sleep,shoulder joints hurt

Release 9 — 3 months, dose 2

2021-09-22

Symptoms: Covid positive

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	Arthralgia	✓	·	✓
SD	Chest pain	✓	·	✓
SD	Chills	✓	·	✓
SD	Cough	✓	·	✓
SD	COVID-19	·	·	✓
SD	Ear pain	✓	·	✓
SD	Fatigue	✓	✓	✓
SD	Feeling of body temperature change	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Insomnia	✓	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pain in jaw	✓	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rhinorrhoea	✓	·	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Dysphagia	✓	✓	✓
SRO	Ear disorder	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Pharyngeal disorder	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash erythematous	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Scab	✓	✓	✓
SRO	Tongue disorder	✓	✓	✓
SRO	Vision blurred	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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