Z92-64578-00794

3 vaccinations 13 coded responses 30 check-ins 13 free-text entries 0 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 761 / TX
Registered: 2021-03-24

Relationship: Self
Race: American Indian or Alaska Native
Ethnicity: Not Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-03-24
Registered in v-safe
2021-03-24
Dose 1 — Moderna
2021-03-24
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-27
Survey response — days 1–6 daily, dose 1
MedDRA: Increased appetite — Feeling: Good

Free text: Increased appetite on day 2

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-31
Survey response — day 7, dose 1
MedDRA: Vomiting — Feeling: Good · Vomiting

Free text: Threw up over night but it was from what i ate and not the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-15
Survey response — day 21, dose 1
MedDRA: Asthenia, Fatigue, Feeling abnormal — Feeling: Fair

Free text: Tired. Energy depletes quicker than before first shot. Work 3 days off 4 regular schedule but rested 2 days & didnt do much other 2 . Probably Able to do normal activities but Chose to not do them. Not sick. Not exhausted. But tiredBit of brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Dose 2 — Moderna
2021-04-22
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Feeling abnormal — Feeling: Good · Site: Pain · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Rainey & 50s evening. Worked 2 hrs on day off Tireder than usual.Some brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal, Oropharyngeal pain — Feeling: Fair · Fatigue or tiredness

Free text: Sore throat early morning.didnt last long. Still some brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Insomnia — Feeling: Fair · Fatigue or tiredness

Free text: Not sleep well. Not very hungry

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Pain in extremity — Feeling: Good · Fatigue or tiredness

Free text: Arms & back sore from working in yard

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Fatigue — Feeling: Fair · Fatigue or tiredness

Free text: 2 late 2 report yesterday after work. Same as 2day. Easily tired. Low energy. Routine work makes me Very tired. More so than usual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Survey response — day 7, dose 2
MedDRA: Asthenia, Brain fog, Emotional disorder, Fatigue — Feeling: Fair · Fatigue or tiredness

Free text: Still tired. Low energy. Dont want to do much. Massage 2day. Will rest & see if its better 2morrow. First of 4 days off. Some brain fog and more emotional than usual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-15
Survey response — day 21, dose 2
MedDRA: Brain fog, Fatigue, Memory impairment, Myalgia — Feeling: Fair

Free text: Still tired most of the time. Fatigue has become muscle aches when exerting myself. Getting some things done but lots of resting. 3 day work 4 day off. Still some brain fog. Forgetting simple things. Not wanting to do much but not sick 2 go 2 dr.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-27
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-06-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-09
Dose 3 — Moderna
2022-01-06
Survey response — day 28, dose 3
MedDRA: Balance disorder, Brain fog, Chills, Diarrhoea, Fatigue, Headache, Pyrexia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Diarhrea. Chills fever. Fatigue. Headache brain fog balance issues

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-01-20
Survey response — day 42, dose 3
MedDRA: Asthenia, Balance disorder, Brain fog, Disturbance in attention, Eye discharge, Fall, Fatigue, Lacrimation increased, Vision blurred — Feeling: Fair

Free text: Continuing balance issues. Fallen down only once. A little loss of balance almost every day. Brain fog. Loss of concentration. Tears are thick and muccasy. Blurs my vision. Continued easily fatigued. Energy not back 2 b4 covid levels

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-11
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-12-11
Survey response — 12 months, dose 3
MedDRA: Cough, Fatigue, Incontinence, Pain, Pyrexia, SARS-CoV-2 test negative — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fever. Body aches. Fatigue. Uncontrolled cough with incontenance. Tested negative for covid with home test

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-24	Moderna
2	2021-04-22	Moderna
3	2021-12-09	Moderna	No

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-27

Systemic reaction (other): Increased appetite on day 2

Release 6 — day 7, dose 1

2021-03-31

Systemic reaction (other): Threw up over night but it was from what i ate and not the shot

Release 7 — day 21, dose 1

2021-04-15

Symptoms: Tired. Energy depletes quicker than before first shot. Work 3 days off 4 regular schedule but rested 2 days & didnt do much other 2 . Probably Able to do normal activities but Chose to not do them. Not sick. Not exhausted. But tiredBit of brain fog cut off by CDC

Release 7 — days 1–6 daily, dose 2

2021-04-23

Systemic reaction (other): Rainey & 50s evening. Worked 2 hrs on day off Tireder than usual.Some brain fog

2021-04-24

Systemic reaction (other): Sore throat early morning.didnt last long. Still some brain fog

2021-04-25

Systemic reaction (other): Not sleep well. Not very hungry

2021-04-26

Systemic reaction (other): Arms & back sore from working in yard

Release 8 — days 1–6 daily, dose 2

2021-04-28

Systemic reaction (other): 2 late 2 report yesterday after work. Same as 2day. Easily tired. Low energy. Routine work makes me Very tired. More so than usual

Release 8 — day 7, dose 2

2021-04-29

Systemic reaction (other): Still tired. Low energy. Dont want to do much. Massage 2day. Will rest & see if its better 2morrow. First of 4 days off. Some brain fog and more emotional than usual

Release 8 — day 21, dose 2

2021-05-15

Symptoms: Still tired most of the time. Fatigue has become muscle aches when exerting myself. Getting some things done but lots of resting. 3 day work 4 day off. Still some brain fog. Forgetting simple things. Not wanting to do much but not sick 2 go 2 dr.

Release 10 — day 28, dose 3

2022-01-06

Symptoms: Diarhrea. Chills fever. Fatigue. Headache brain fog balance issues

Release 10 — day 42, dose 3

2022-01-20

Symptoms: Continuing balance issues. Fallen down only once. A little loss of balance almost every day. Brain fog. Loss of concentration. Tears are thick and muccasy. Blurs my vision. Continued easily fatigued. Energy not back 2 b4 covid levels

Release 12 — 12 months, dose 3

2022-12-11

Symptoms: Fever. Body aches. Fatigue. Uncontrolled cough with incontenance. Tested negative for covid with home test

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
SD	Asthenia	✓	✓	✓
SD	Balance disorder	·	·	✓
SD	Brain fog	✓	✓	✓
SD	Chills	·	·	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Disturbance in attention	·	·	✓
SD	Eye discharge	·	·	✓
SD	Fall	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Headache	·	·	✓
SD	Incontinence	·	·	✓
SD	Lacrimation increased	·	·	✓
SD	Memory impairment	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Vision blurred	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Brain fog	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Emotional disorder	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Increased appetite	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Vomiting	✓	✓	✓

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