Z7Z-33381-41881

2 vaccinations 7 coded responses 19 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 640 / MO
Registered: 2021-02-24

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

2021-02-23
Dose 1 — Moderna
2021-02-24
Registered in v-safe
2021-03-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-16
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-23
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-29
Dose 2 — Moderna
2021-03-29
Survey response — day 0, dose 2
MedDRA: Dizziness, Eye pruritus — Feeling: Good

Free text: Left eye itches again, dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — 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: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Fever

Free text: But at 2 am getting better

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: Localised oedema, Oedema peripheral, Tenderness — Feeling: Good

Free text: L lateral neck, axilla edema, tender. Inj on L deltoid

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-19
Survey response — day 21, dose 2
MedDRA: Cough, Pain in extremity, Pyrexia, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Poor · 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: Symptoms: 102 fever, aches, cough, runny nose- thought allergies till the fever. Now on steroids, inhaler and antibiotic · Healthcare visit (other): Covid test negative

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Report sent to call center — day 21, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-26
Survey response — day 28, dose 2
MedDRA: Cough, Discharge, Nasopharyngitis, Pain, Pyrexia, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Seems to be a viral cold so fever, aches, runny nose, cough - clear drainage post steroid pack. HA, etc

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-04
Survey response — day 35, dose 2
MedDRA: Hypersensitivity, Kidney infection, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Kidney infection. Allergy sx clearing. On Cipro BID now which should clear remaining Sx- none of these are vaccination occurrences- random. · Healthcare visit (other): Dr visit- pcp

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-30
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-01
Call 1 — Left Voicemail
2022-04-01
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-23	Moderna
2	2021-03-29	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-19	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-04-26	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-05-04	Successful 2022-04-01	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 6 — day 0, dose 2

2021-03-29

Systemic reaction (other): Left eye itches again, dizziness

Release 6 — days 1–6 daily, dose 2

2021-03-30

Systemic reaction (other): Dizziness

2021-03-31

Systemic reaction (other): But at 2 am getting better

2021-04-01

Systemic reaction (other): L lateral neck, axilla edema, tender. Inj on L deltoid

Release 7 — day 21, dose 2

2021-04-19

Symptoms: 102 fever, aches, cough, runny nose- thought allergies till the fever. Now on steroids, inhaler and antibiotic

Healthcare visit (other): Covid test negative

Release 8 — day 28, dose 2

2021-04-26

Symptoms: Seems to be a viral cold so fever, aches, runny nose, cough - clear drainage post steroid pack. HA, etc

Release 8 — day 35, dose 2

2021-05-04

Symptoms: Kidney infection. Allergy sx clearing. On Cipro BID now which should clear remaining Sx- none of these are vaccination occurrences- random.

Healthcare visit (other): Dr visit- pcp

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	SARS-CoV-2 test negative	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Discharge	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Kidney infection	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Eye pruritus	✓	✓	✓
SRO	Localised oedema	✓	✓	✓
SRO	Oedema peripheral	✓	✓	✓
SRO	Tenderness	✓	✓	✓

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