Z77-31610-20230

2 vaccinations 11 coded responses 23 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 465 / IN
Registered: 2021-02-02

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

2021-02-02
Registered in v-safe
2021-02-02
Dose 1 — Moderna
2021-02-02
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Myalgia — Feeling: Fair · Diarrhea

Free text: little bit joint and muscle but not alot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspepsia — Feeling: Good

Free text: acid stomach

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Pain — Feeling: Fair · Muscle or body aches

Free text: my pains probably aren't related to shot, been doing alot of physical things and adjusted at chiropractor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort, Gastric pH decreased, Pain — Feeling: Fair · Muscle or body aches, Nausea

Free text: had massage and some aches maybe from that. after big dinner feeling Sicky stomach and some acidic stomach occasionally

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Pain — Feeling: Good · Headache, Muscle or body aches

Free text: occasional headache, some aches a bit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — day 7, dose 1
Feeling: Good · Nausea

Adult check-in
2021-02-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-23
Survey response — day 21, dose 1
MedDRA: Back pain, Dizziness, Fatigue, Headache, Nausea, Vertigo, Vomiting — Feeling: Poor · Be unable to do your normal daily activities

Free text: had vertigo, headache, nauseous, threw up last wed and Thursday morn. was tired. felt better but some dizzyness occasionally. some vertigo today, bit of queezy and headache, some back ache. my adult son also same with no shot..probably a bug

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Dose 2 — Moderna
2021-03-03
Survey response — day 0, dose 2
MedDRA: Pre-existing disease, Sinus headache, Vertigo — Feeling: Fair · Muscle or body aches

Free text: previous to shot I have been having ear ache and earlier this week little vertigo , I don't think related to shotsnor covid. also sinus headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Muscle or body aches

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Paranasal sinus discomfort — Feeling: Fair · Muscle or body aches, Diarrhea

Free text: earache, sinus pressuers

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Sinus disorder — Feeling: Good · Headache, Muscle or body aches, Diarrhea

Free text: earache , sinus, also was traveling

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

Adult check-in
2021-03-10
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-31
Survey response — day 28, dose 2
MedDRA: Headache, Hypertension — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Extremely high blood pressure, head aches. In for scheduled Dr appt 6 mo check up · Healthcare visit (other): 6 mo check up bp high

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Survey response — 3 months, dose 2
MedDRA: Cough — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: I caught cough cold going around. I'm getting over it now. I also traveled and had some jetlag. Had a crash day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2022-01-23
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-02	Moderna
2	2021-03-03	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-31	Successful 2022-01-23	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-03

Systemic reaction (other): little bit joint and muscle but not alot

2021-02-04

Systemic reaction (other): acid stomach

2021-02-05

Systemic reaction (other): my pains probably aren't related to shot, been doing alot of physical things and adjusted at chiropractor

2021-02-06

Systemic reaction (other): had massage and some aches maybe from that. after big dinner feeling Sicky stomach and some acidic stomach occasionally

2021-02-08

Systemic reaction (other): occasional headache, some aches a bit

Release 4 — day 21, dose 1

2021-02-23

Symptoms: had vertigo, headache, nauseous, threw up last wed and Thursday morn. was tired. felt better but some dizzyness occasionally. some vertigo today, bit of queezy and headache, some back ache. my adult son also same with no shot..probably a bug cut off by CDC

Release 4 — day 0, dose 2

2021-03-03

Systemic reaction (other): previous to shot I have been having ear ache and earlier this week little vertigo , I don't think related to shotsnor covid. also sinus headaches

Release 5 — days 1–6 daily, dose 2

2021-03-07

Systemic reaction (other): earache, sinus pressuers

2021-03-08

Systemic reaction (other): earache , sinus, also was traveling

Release 6 — day 28, dose 2

2021-03-31

Symptoms: Extremely high blood pressure, head aches. In for scheduled Dr appt 6 mo check up

Healthcare visit (other): 6 mo check up bp high

Release 8 — 3 months, dose 2

2021-06-03

Symptoms: I caught cough cold going around. I'm getting over it now. I also traveled and had some jetlag. Had a crash day.

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	Hypertension	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Vertigo	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Dyspepsia	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Gastric pH decreased	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Paranasal sinus discomfort	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Sinus disorder	✓	✓	✓
SRO	Sinus headache	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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