Z82-27126-50891

3 vaccinations 4 coded responses 7 check-ins 4 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 201 / VA
Registered: 2021-03-26

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-27
Dose 1 — Moderna
2021-02-24
Dose 2 — Moderna
2021-03-26
Registered in v-safe
2021-03-26
Survey response — day 28, dose 2
MedDRA: Asthenia, Back pain, Blood pressure increased, Chills, Headache, Malaise, Musculoskeletal stiffness, Pyrexia, SARS-CoV-2 test — 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

Free text: Symptoms: Head aches, fever & chills, BP spikes, general malaise, weakness, body stiffness, new symptom is lower back pain. Symptoms increased since 2/24/2021 · Healthcare visit (other): Covid-19 test, blood test

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
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)
2021-03-31
Survey response — day 35, dose 2
MedDRA: Blood pressure decreased, Dizziness, Headache, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Blood pressure sudden drop. Feeljng faint 96/49. Headaches · Healthcare visit (other): In office visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
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)
2021-04-09
Survey response — day 42, dose 2
MedDRA: Balance disorder, Blood pressure abnormal, Headache, Hormone level abnormal, Hypertension, Nausea, Vertigo — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Erratic blood pressure, head aches, serious vertigo symptoms of room spinning, nausea, imbalanced

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-16
Call 1 — Could Not Reach Participant
2021-12-21
Call 2 — Could Not Reach Participant
2022-02-15
Dose 3 — Moderna
2022-03-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-05-17
Survey response — 3 months, dose 3
MedDRA: Blood pressure increased, Hospitalisation, Incomplete course of vaccination, Neurological symptom, Office visit, Vaccine positive rechallenge — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Same as last year 2021 after i took Covid 19 2nd shot in Feb. This year Feb 2022 i took the booster. BP surges started in march/April. Hospitalized 3 xs stroke levels BP unprovoked. Dr. Suggests no further Covid vaccinations.

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-18
Call successful
Participant prefers to complete VAERS report online
2022-05-18
Call successful
Participant prefers to complete VAERS report online
2022-05-18
Call successful
Participant prefers to complete VAERS report online
2022-05-18
Call successful
Participant prefers to complete VAERS report online
2022-08-16
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-27	Moderna
2	2021-02-24	Moderna
3	2022-02-15	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-26	Successful 2022-05-18	Participant prefers to complete VAERS report online
2021-03-31	Successful 2022-05-18	Participant prefers to complete VAERS report online
2021-04-09	Successful 2022-05-18	Participant prefers to complete VAERS report online
2022-05-17	Successful 2022-05-18	Participant prefers to complete VAERS report online

Free text

Release 6 — day 28, dose 2

2021-03-26

Symptoms: Head aches, fever & chills, BP spikes, general malaise, weakness, body stiffness, new symptom is lower back pain. Symptoms increased since 2/24/2021

Healthcare visit (other): Covid-19 test, blood test

Release 6 — day 35, dose 2

2021-03-31

Symptoms: Blood pressure sudden drop. Feeljng faint 96/49. Headaches

Healthcare visit (other): In office visit

Release 7 — day 42, dose 2

2021-04-09

Symptoms: Erratic blood pressure, head aches, serious vertigo symptoms of room spinning, nausea, imbalanced

Release 11 — 3 months, dose 3

2022-05-17

Symptoms: Same as last year 2021 after i took Covid 19 2nd shot in Feb. This year Feb 2022 i took the booster. BP surges started in march/April. Hospitalized 3 xs stroke levels BP unprovoked. Dr. Suggests no further Covid vaccinations.

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	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Balance disorder	✓	·	✓
SD	Blood pressure abnormal	✓	·	✓
SD	Blood pressure decreased	✓	✓	✓
SD	Blood pressure increased	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hormone level abnormal	○	✓	○
SD	Hospitalisation	·	·	✓
SD	Hypertension	○	✓	○
SD	Incomplete course of vaccination	·	·	✓
SD	Malaise	✓	✓	✓
SD	Musculoskeletal stiffness	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Neurological symptom	·	·	✓
SD	Office visit	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Vaccine positive rechallenge	·	·	✓
SD	Vertigo	✓	✓	✓

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