Z85-14243-32680

3 vaccinations 3 coded responses 40 check-ins 3 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 923 / CA
Registered: 2021-04-06

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

2021-04-06
Registered in v-safe
2021-04-06
Dose 1 — Moderna
2021-04-06
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Redness · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches

Adult check-in
2021-04-13
Health check-in — day 7, dose 1
Feeling: Fair · None

Adult check-in
2021-04-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-05-04
Dose 2 — Moderna
2021-05-04
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · None

Adult check-in
2021-05-05
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · None

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-05-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · None

Adult check-in
2021-05-11
Health check-in — day 7, dose 2
Feeling: Fair · None

Adult check-in
2021-05-18
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-06-01
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-06-08
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-15
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-08-03
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-11-02
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-12-23
Dose 3 — Moderna
2021-12-23
Health check-in — day 0, dose 3
Feeling: Fair · None

Adult check-in
2021-12-24
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-25
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-26
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-27
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-12-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-12-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-12-30
Health check-in — day 7, dose 3
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-01-06
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2022-01-13
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-01-20
Survey response — day 28, dose 3
MedDRA: Cough, Increased viscosity of bronchial secretion, Sputum discoloured — Feeling: Poor · Be unable to do your normal daily activities

Free text: Nonstop Coughing for 2 days O2 Saturation 93, Green Thick Sputum, Trying to get a Dr. Appointment

MedDRA releases: 2024-11 · check-in free text available
2022-01-27
Health check-in — day 35, dose 3
Feeling: Poor

Adult check-in
2022-02-03
Health check-in — day 42, dose 3
Feeling: Poor

Adult check-in
2022-03-24
Survey response — 3 months, dose 3
MedDRA: Brain fog, Breakthrough COVID-19, Condition aggravated, Cough, Cyst, Dyspnoea, Fatigue, Headache, Malaise, Pre-existing disease — 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: I got breakthrough Covid 19 in January and it is now long COVID.Affecting my COPD and tired, headaches, Cough. Shortness of breath,Also brain fog. And I always wore a mask and rarely went anywhere. Also I have a Knee problem that is worse wrist Cyst · Healthcare visit (other): My FiancÃ© got a Positive PCR Saliva test from work onJanuary 22 and we both have been sick ever since and he was vaccinated and Boosted with Pfizer

MedDRA releases: 2024-11 · check-in free text available
2022-03-24
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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-03-28
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-06-23
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-06	Moderna
2	2021-05-04	Moderna
3	2021-12-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-03-24	Successful 2022-03-28	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 7 — day 0, dose 1

2021-04-06

Systemic reaction (other): No

Release 10 — day 28, dose 3

2022-01-20

Symptoms: Nonstop Coughing for 2 days O2 Saturation 93, Green Thick Sputum, Trying to get a Dr. Appointment

Release 11 — 3 months, dose 3

2022-03-24

Symptoms: I got breakthrough Covid 19 in January and it is now long COVID.Affecting my COPD and tired, headaches, Cough. Shortness of breath,Also brain fog. And I always wore a mask and rarely went anywhere. Also I have a Knee problem that is worse wrist Cyst cut off by CDC

Healthcare visit (other): My FiancÃ© got a Positive PCR Saliva test from work onJanuary 22 and we both have been sick ever since and he was vaccinated and Boosted with Pfizer

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	Malaise	·	·	✓
SD	Brain fog	·	·	✓
SD	Breakthrough COVID-19	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	Cyst	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Increased viscosity of bronchial secretion	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sputum discoloured	·	·	✓
SRO	No adverse event	✓	✓	✓

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