Z7N-13024-16591
2 vaccinations
7 coded responses
24 check-ins
7 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 070 / NJ
- Registered
- 2021-02-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-28
Registered in v-safe
-
2021-02-28
Dose 1 — Moderna
- 2021-02-28
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2021-03-01
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia, Pain in extremity — Feeling: Good · Site: Pain · Headache, Joint pains, Fatigue or tirednessFree text: I had Total Shoulder Replacement (TSR) both shoulders. I DID NOT want this shot into my upper arm,i wanted it in my thigh. The arm i had the shot still hurts from surgery but I WOULD not have the injection in my dominant arm which DOES not hurt. So my shoulder joint hurts more drthen it did from having the injection.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-14
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2021-03-21
Survey response — day 21, dose 1MedDRA: Arthralgia — Feeling: GoodFree text: My joints acheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-28
Dose 2 — Moderna
- 2021-03-28
-
2021-03-29
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-03-30
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
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2021-03-31
Survey response — days 1–6 daily, dose 2MedDRA: Feeling abnormal, Heart rate increased — Feeling: Fair · Site: Pain · Joint painsFree text: My heart is beating to hard just not feeling rigjtMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-01
Survey response — days 1–6 daily, dose 2MedDRA: Musculoskeletal discomfort, Oral pain, Palpitations — Feeling: GoodFree text: Heart racing ,joint discomfort,throbbing in mouthMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-02
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue — Feeling: Fair · Fatigue or tirednessFree text: TiredMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-04
- 2021-04-11
- 2021-04-18
- 2021-04-25
- 2021-05-02
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2021-06-27
Survey response — 3 months, dose 2MedDRA: Internal haemorrhage — Feeling: Fair · 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, Emergency room or emergency department visit, HospitalizationFree text: Internal bleedingHemoglobin 5MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-27
Report sent to call center — 3 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
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2021-07-01
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
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2021-09-26
Survey response — 6 months, dose 2MedDRA: Dental restoration failure, Gastrointestinal haemorrhage, Hospitalisation, Office visit, Transfusion — Feeling: Good · Be unable to do your normal daily activitiesFree text: I had a dental implant that failed 2 weeks after my 2nd shot2 months after my 2nd shot i had a GI bleed. After many dr. visits,blood tests and medical tests cause of the GI bleed unknown. I was hospitalized and needed blood infusionsMedDRA releases: 2024-11 · check-in free text available
- 2022-03-28
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-28 | Moderna | |
| 2 | 2021-03-28 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-06-27 | Successful 2021-07-01 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): I had Total Shoulder Replacement (TSR) both shoulders. I DID NOT want this shot into my upper arm,i wanted it in my thigh. The arm i had the shot still hurts from surgery but I WOULD not have the injection in my dominant arm which DOES not hurt. So my shoulder joint hurts more drthen it did from having the injection.
Release 6 — day 21, dose 1
Symptoms: My joints ache
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): My heart is beating to hard just not feeling rigjt
Systemic reaction (other): Heart racing ,joint discomfort,throbbing in mouth
Systemic reaction (other): Tired
Release 9 — 3 months, dose 2
Symptoms: Internal bleedingHemoglobin 5
Release 9 — 6 months, dose 2
Symptoms: I had a dental implant that failed 2 weeks after my 2nd shot2 months after my 2nd shot i had a GI bleed. After many dr. visits,blood tests and medical tests cause of the GI bleed unknown. I was hospitalized and needed blood infusions
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 | Dental restoration failure | · | · | ✓ |
| SD | Gastrointestinal haemorrhage | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Internal haemorrhage | ✓ | ✓ | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Transfusion | · | · | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | Heart rate increased | ✓ | ✓ | ✓ |
| SRO | Musculoskeletal discomfort | ✓ | ✓ | ✓ |
| SRO | Oral pain | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Palpitations | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release