Z93-27617-36547

2 vaccinations 13 coded responses 14 check-ins 13 free-text entries 9 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 974 / OR
Registered: 2021-01-24

Relationship: Self
Race: Other
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-24
Registered in v-safe
2021-01-24
Dose 1 — Moderna
2021-01-24
Survey response — day 0, dose 1
MedDRA: Unevaluable event — Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site

Free text: These are all related to my chronic situation.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Blood glucose increased, Medical observation — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Blood sugar was 360 after injection and having difficulty bringing it back under control since injection · Healthcare visit (other): Phone to doctor at the office for information and advice.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-29
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Poor · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Congenital defects . I don't have covid-19 or flu.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Diabetes, hereditary pancreatitis, vitamin deficiency

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Survey response — day 7, dose 1
MedDRA: Abdominal pain, Back pain, Biliary colic — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Abdominal pain, back pain, md said gall bladder maybe

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Report sent to call center — day 7, 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)
2021-02-09
Survey response — day 14, dose 1
MedDRA: Abdominal discomfort, Cholecystitis, Gastrointestinal inflammation, Pancreatitis — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Gastric distress, inflammation, cholecystitis and pancreatitis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Report sent to call center — day 14, 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)
2021-02-14
Survey response — day 21, dose 1
MedDRA: Gallbladder disorder, Pancreatitis — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Gall bladder and pancreatitis

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Report sent to call center — day 21, 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)
2021-02-21
Survey response — day 28, dose 1
MedDRA: Abdominal pain, Back pain, Diarrhoea, Nausea — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Nausea and severe diarrhea, abdominal and back pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Report sent to call center — day 28, 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)
2021-03-01
Dose 2 — Moderna
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Telemedicine — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Nausea, Diarrhea · Be unable to work, 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: Phone consult with md at er

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Report sent to call center — days 1–6 daily, 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)
2021-03-05
Survey response — days 1–6 daily, dose 2
MedDRA: Blood glucose abnormal — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Can't seem to get my blood sugar back under control since the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Office visit, Unevaluable event — Feeling: Good · Site: Pain, Swelling · Headache, Joint pains, Diarrhea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): All members of the family have recovered from moderna booster side effects and have returned to baseline. · Healthcare visit (other): Doctor appointment in the office

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-08
Survey response — day 7, dose 2
MedDRA: Office visit — Feeling: Good · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Diarrhea, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Went to doctor appointment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Report sent to call center — day 7, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-30
Survey response — 6 months, dose 2
MedDRA: Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Scalp and Facial rash · Healthcare visit (other): Routine PCP visit only

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-30
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-02
Call successful
Does not wish to fill out VAERS report
2021-09-02
Call successful
Does not wish to fill out VAERS report
2021-09-02
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-24	Moderna
2	2021-03-01	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-26	Successful	Does not wish to fill out VAERS report
2021-02-02	Successful	Does not wish to fill out VAERS report
2021-02-09	Successful	Does not wish to fill out VAERS report
2021-02-14	Successful	Does not wish to fill out VAERS report
2021-02-21	Successful	Does not wish to fill out VAERS report
2021-03-03	Successful	Does not wish to fill out VAERS report
2021-03-07	Successful 2021-09-02	Does not wish to fill out VAERS report
2021-03-08	Successful 2021-09-02	Does not wish to fill out VAERS report
2021-08-30	Successful 2021-09-02	Does not wish to fill out VAERS report

Free text

Release 2 — day 0, dose 1

2021-01-24

Systemic reaction (other): These are all related to my chronic situation.

Release 2 — days 1–6 daily, dose 1

2021-01-26

Systemic reaction (other): Blood sugar was 360 after injection and having difficulty bringing it back under control since injection

Healthcare visit (other): Phone to doctor at the office for information and advice.

Release 3 — days 1–6 daily, dose 1

2021-01-29

Systemic reaction (other): Congenital defects . I don't have covid-19 or flu.

2021-01-30

Systemic reaction (other): Diabetes, hereditary pancreatitis, vitamin deficiency

Release 3 — day 7, dose 1

2021-02-02

Systemic reaction (other): Abdominal pain, back pain, md said gall bladder maybe

Release 3 — day 14, dose 1

2021-02-09

Symptoms: Gastric distress, inflammation, cholecystitis and pancreatitis.

Release 4 — day 21, dose 1

2021-02-14

Symptoms: Gall bladder and pancreatitis

Release 4 — day 28, dose 1

2021-02-21

Symptoms: Nausea and severe diarrhea, abdominal and back pain.

Release 5 — days 1–6 daily, dose 2

2021-03-03

Healthcare visit (other): Phone consult with md at er

2021-03-05

Systemic reaction (other): Can't seem to get my blood sugar back under control since the vaccine.

2021-03-07

Systemic reaction (other): All members of the family have recovered from moderna booster side effects and have returned to baseline.

Healthcare visit (other): Doctor appointment in the office

Release 5 — day 7, dose 2

2021-03-08

Healthcare visit (other): Went to doctor appointment

Release 9 — 6 months, dose 2

2021-08-30

Symptoms: Scalp and Facial rash

Healthcare visit (other): Routine PCP visit only

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 observation	✓	✓	✓
HCVO	Office visit	✓	✓	✓
HCVO	Telemedicine	✓	✓	✓
SD	Abdominal discomfort	✓	✓	✓
SD	Abdominal pain	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Cholecystitis	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Gallbladder disorder	✓	✓	✓
SD	Gastrointestinal inflammation	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pancreatitis	✓	✓	✓
SD	Rash	✓	·	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Biliary colic	✓	✓	✓
SRO	Blood glucose abnormal	✓	✓	✓
SRO	Blood glucose increased	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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