Z8R-19222-08819

2 vaccinations 11 coded responses 13 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 613 / IL
Registered: 2021-08-28

Relationship: Self
Race: White
Ethnicity: N/A

Timeline

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

2021-07-24
Dose 1 — Moderna
2021-08-26
Dose 2 — Moderna
2021-08-28
Registered in v-safe
2021-08-28
Survey response — days 1–6 daily, dose 2
MedDRA: Irritability — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: irritable

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-31
Survey response — days 1–6 daily, dose 2
MedDRA: Confusional state, Dizziness, Oropharyngeal pain — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Sore throat, lightheaded, confusion. I had Alot of symtoms yesterday but didnt notice that any daily check came. Waited for it. It was too late today today to report it once i looked.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-01
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Injection site rash, Rash erythematous — Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Cough, yesterday and today. Rash:] My redness has extended past the immediate area of the injection site since reporting started.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-02
Survey response — day 7, dose 2
MedDRA: Cough — Feeling: Fair · Site: Pain, Redness, Itching · Muscle or body aches

Free text: Cough

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-10
Survey response — day 14, dose 2
MedDRA: Pain, Pain in extremity — Feeling: Fair

Free text: My shot arm hurting, with use.

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
Survey response — day 21, dose 2
MedDRA: Myalgia, Pain, Pre-existing disease, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Muscle aches. Old injuries, old pain is back. · Healthcare visit (other): Will discuss with Dr. in upcoming visit.

MedDRA releases: 2024-11 · check-in free text available
2021-09-17
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)
2021-09-20
Call 1 — Left Voicemail
2021-09-25
Survey response — day 28, dose 2
MedDRA: Arthralgia, Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Again, points of old injuries hurting. Left wrist was in alot of pain.

MedDRA releases: 2024-11 · check-in free text available
2021-09-30
Survey response — day 35, dose 2
MedDRA: Bloody discharge, Epistaxis, Paranasal sinus discomfort, Respiratory tract congestion, Sinus pain — Feeling: Good

Free text: Bloody nose. I had bloody discharge last week and didnt think much cause i didnt feel sick. I think it bothered me a day or two.This week, i blew my nose and it was full of mucosy blood. Congestion for a few days with discomfort and pain in sinus

MedDRA releases: 2024-11 · check-in free text available
2021-10-10
Survey response — day 42, dose 2
MedDRA: Myalgia, Sinusitis — Feeling: Good

Free text: Sinus infection. Still have muscle pain in my left arm. I have felt pain in my lower arm for about a month now that i've suspected had to do with having gotten muscle problems with my shot.

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Survey response — 3 months, dose 2
MedDRA: Chest discomfort, Nasopharyngitis, Unevaluable event — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Chest discomfort at times. I currrntly have a bad cold, sinus.

MedDRA releases: 2024-11 · check-in free text available
2022-02-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-08-27
Survey response — 12 months, dose 2
MedDRA: Anxiety — Feeling: Good

Free text: Higher anxiety levels

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-24	Moderna	No
2	2021-08-26	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-17	Unsuccessful

Free text

Release 9 — days 1–6 daily, dose 2

2021-08-28

Systemic reaction (other): irritable

2021-08-31

Systemic reaction (other): Sore throat, lightheaded, confusion. I had Alot of symtoms yesterday but didnt notice that any daily check came. Waited for it. It was too late today today to report it once i looked.

2021-09-01

Systemic reaction (other): Cough, yesterday and today. Rash:] My redness has extended past the immediate area of the injection site since reporting started.

Release 9 — day 7, dose 2

2021-09-02

Systemic reaction (other): Cough

Release 9 — day 14, dose 2

2021-09-10

Symptoms: My shot arm hurting, with use.

Release 9 — day 21, dose 2

2021-09-17

Symptoms: Muscle aches. Old injuries, old pain is back.

Healthcare visit (other): Will discuss with Dr. in upcoming visit.

Release 9 — day 28, dose 2

2021-09-25

Symptoms: Again, points of old injuries hurting. Left wrist was in alot of pain.

Release 9 — day 35, dose 2

2021-09-30

Symptoms: Bloody nose. I had bloody discharge last week and didnt think much cause i didnt feel sick. I think it bothered me a day or two.This week, i blew my nose and it was full of mucosy blood. Congestion for a few days with discomfort and pain in sinus cut off by CDC

Release 10 — day 42, dose 2

2021-10-10

Symptoms: Sinus infection. Still have muscle pain in my left arm. I have felt pain in my lower arm for about a month now that i've suspected had to do with having gotten muscle problems with my shot.

Release 10 — 3 months, dose 2

2021-11-27

Symptoms: Chest discomfort at times. I currrntly have a bad cold, sinus.

Release 12 — 12 months, dose 2

2022-08-27

Symptoms: Higher anxiety levels

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	Unevaluable event	·	·	✓
SD	Anxiety	·	·	✓
SD	Arthralgia	·	·	✓
SD	Bloody discharge	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Epistaxis	·	·	✓
SD	Myalgia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Paranasal sinus discomfort	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Sinus pain	·	·	✓
SD	Sinusitis	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Confusional state	✓	·	✓
SRO	Cough	✓	·	✓
SRO	Dizziness	✓	·	✓
SRO	Injection site rash	✓	·	✓
SRO	Irritability	✓	·	✓
SRO	Oropharyngeal pain	✓	·	✓
SRO	Rash erythematous	✓	·	✓

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