Z8C-19705-48947

1 vaccination 7 coded responses 7 check-ins 7 free-text entries 3 call cases

Sex: —
Age at first dose: 41-45
ZIP prefix: 834 / ID
Registered: 2021-04-09

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-04-09
Registered in v-safe
2021-04-09
Dose 1 — Moderna
2021-04-10
Survey response — days 1–6 daily, dose 1
MedDRA: Anxiety, Dehydration, Dizziness, Mental impairment, Pre-existing disease — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: dizzy, dehydrated, slow to understand or respond, different anxiety than my usual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 1
MedDRA: Balance disorder, Cough, Feeling abnormal, Feeling jittery — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Had severe cough Friday and Saturday, still cough but improvement. Feel foggy, jittery, off balance.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Cough, Medical counselling, Musculoskeletal chest pain, Pulmonary pain — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I still have a cough. My lungs/chest/ribs ache and hurt as when have severe pneumonia. · Healthcare visit (other): I talked with my primary and another health care provider. Made an appt.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Report sent to call center — days 1–6 daily, dose 1
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)
2021-04-13
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea, Pulmonary pain — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Severe lung pain issues breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Pulmonary pain — Feeling: Fair · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Pain in lungs and chest

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — day 14, dose 1
MedDRA: Cough, Dyspnoea, Fatigue, Pyrexia — 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: Increased Fever, fatigue, coughing, breathing issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-08
Survey response — 6 months, dose 1
MedDRA: Pain, Respiratory disorder — Feeling: Fair · 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: Respiratory issues, increased pain

MedDRA releases: 2024-11 · check-in free text available
2021-10-08
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-11
Call 1 — Left Voicemail
2021-10-11
Call 1 — Left Voicemail
2021-10-11
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-09	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-12	Unsuccessful
2021-04-25	Unsuccessful
2021-10-08	Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-10

Systemic reaction (other): dizzy, dehydrated, slow to understand or respond, different anxiety than my usual

2021-04-11

Systemic reaction (other): Had severe cough Friday and Saturday, still cough but improvement. Feel foggy, jittery, off balance.

2021-04-12

Systemic reaction (other): I still have a cough. My lungs/chest/ribs ache and hurt as when have severe pneumonia.

Healthcare visit (other): I talked with my primary and another health care provider. Made an appt.

2021-04-13

Systemic reaction (other): Severe lung pain issues breathing

2021-04-15

Systemic reaction (other): Pain in lungs and chest

Release 7 — day 14, dose 1

2021-04-25

Symptoms: Increased Fever, fatigue, coughing, breathing issues

Release 10 — 6 months, dose 1

2021-10-08

Symptoms: Respiratory issues, increased pain

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	Medical counselling	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Pain	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Respiratory disorder	·	·	✓
SRO	Anxiety	✓	✓	✓
SRO	Balance disorder	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dehydration	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Feeling jittery	✓	✓	✓
SRO	Mental impairment	✓	✓	✓
SRO	Musculoskeletal chest pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pulmonary pain	✓	✓	✓

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