Z6Q-14496-63633

2 vaccinations 6 coded responses 11 check-ins 6 free-text entries 2 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 781 / TX
Registered: 2021-08-15

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline

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

2021-08-13
Dose 1 — Moderna
2021-08-15
Registered in v-safe
2021-08-15
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal pain, Chills, Feeling abnormal, Feeling hot, Headache, Immediate post-injection reaction, Mobility decreased, Nausea, Pain, Pain in extremity, Salivary hypersecretion — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Right after shot vain warmth down my arm, light floating feeling, nausea mouth water, later sore arm, the night with body aches, headache and chills. Next day felt the same after eating another day down

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-08-18
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Just on shot site, sore

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site swelling — Feeling: Good

Free text: Small bump on site.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-20
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-08-27
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-09-03
Survey response — day 21, dose 1
MedDRA: Asthma, Chest discomfort, Influenza, Joint stiffness, Pre-existing disease, Productive cough, Secretion discharge — Feeling: Fair · Be unable to do your normal daily activities

Free text: So my autoimmune was in submission and now I need to check on it cause my joints in my hands are stiff , like a lock pop. Also my mild asthma is acting up, mucus build up, able to cough it up and out. I think I had the flew.2day mild chest tightness.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-10
Dose 2 — Moderna
2021-09-17
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-09-26
Survey response — day 14, dose 2
MedDRA: Arthritis, Pre-existing disease, Systemic lupus erythematosus — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Arthritis flares, skin stuff I had before meds for Lupus then I stopped, was good until these shots woke up my immune system.

MedDRA releases: 2024-11 · check-in free text available
2021-09-26
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-09-29
Call 1 — Could Not Reach Participant
2021-10-01
Survey response — day 21, dose 2
MedDRA: Immune system disorder, Office visit, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: I dont think this shot helped me, just made my immune system act up again, most likely get back on immune suppressants. Ill be seeing a pmc doctor to send be back to specialist. · Healthcare visit (other): Appointment, well check and to see for my arthritis etc.

MedDRA releases: 2024-11 · check-in free text available
2021-10-01
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-13	Moderna	No
2	2021-09-10	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-26	Unsuccessful
2021-10-01	Unsuccessful

Free text

Release 9 — days 1–6 daily, dose 1

2021-08-15

Systemic reaction (other): Right after shot vain warmth down my arm, light floating feeling, nausea mouth water, later sore arm, the night with body aches, headache and chills. Next day felt the same after eating another day down

2021-08-18

Systemic reaction (other): Just on shot site, sore

2021-08-19

Systemic reaction (other): Small bump on site.

Release 9 — day 21, dose 1

2021-09-03

Symptoms: So my autoimmune was in submission and now I need to check on it cause my joints in my hands are stiff , like a lock pop. Also my mild asthma is acting up, mucus build up, able to cough it up and out. I think I had the flew.2day mild chest tightness. cut off by CDC

Release 9 — day 14, dose 2

2021-09-26

Symptoms: Arthritis flares, skin stuff I had before meds for Lupus then I stopped, was good until these shots woke up my immune system.

Release 9 — day 21, dose 2

2021-10-01

Symptoms: I dont think this shot helped me, just made my immune system act up again, most likely get back on immune suppressants. Ill be seeing a pmc doctor to send be back to specialist.

Healthcare visit (other): Appointment, well check and to see for my arthritis etc.

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	·	·	✓
HCVO	Pre-existing disease	·	·	✓
SD	Arthritis	·	·	✓
SD	Asthma	✓	·	✓
SD	Chest discomfort	✓	·	✓
SD	Immune system disorder	·	·	✓
SD	Influenza	✓	·	✓
SD	Joint stiffness	✓	·	✓
SD	Pre-existing disease	✓	·	✓
SD	Productive cough	✓	·	✓
SD	Secretion discharge	✓	·	✓
SD	Systemic lupus erythematosus	·	·	✓
SRO	Abdominal pain	✓	·	✓
SRO	Chills	✓	·	✓
SRO	Feeling abnormal	✓	·	✓
SRO	Feeling hot	✓	·	✓
SRO	Headache	✓	·	✓
SRO	Immediate post-injection reaction	✓	·	✓
SRO	Injection site pain	✓	·	✓
SRO	Injection site swelling	✓	·	✓
SRO	Mobility decreased	✓	·	✓
SRO	Nausea	✓	·	✓
SRO	Pain	✓	·	✓
SRO	Pain in extremity	✓	·	✓
SRO	Salivary hypersecretion	✓	·	✓

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