Z94-26861-33491

5 vaccinations 7 coded responses 50 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 337 / FL
Registered: 2021-02-13

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

2021-02-12
Dose 1 — Moderna
2021-02-13
Registered in v-safe
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Moderna
2021-03-12
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Fair · Site: Redness · Fatigue or tiredness

Adult check-in
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-11
Survey response — 3 months, dose 2
MedDRA: Fatigue, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Fatigue and muscle pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-10
Dose 3 — Moderna
2021-09-10
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-03-12
Survey response — 12 months, dose 2
MedDRA: Hypersensitivity, Pulmonary mass, Tachycardia — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Allergic reaction, tachycardia, pulmonary nodules

MedDRA releases: 2024-11 · check-in free text available
2022-03-12
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-15
Dose 4 — Moderna
2022-05-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-17
Survey response — days 1–6 daily, dose 4
MedDRA: Heart rate increased — Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Free text: Higher resting pulse

MedDRA releases: 2024-11 · check-in free text available
2022-05-18
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-05-19
Survey response — days 1–6 daily, dose 4
MedDRA: Paraesthesia — Feeling: Good

Free text: Intermittent buzzing not tingling lasting one to two seconds up and down vaccinated arm several times daily since received shot.

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-22
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-29
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-05
Survey response — day 21, dose 4
MedDRA: Office visit, Tooth abscess — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Abscess tooth probably not related · Healthcare visit (other): Dentist

MedDRA releases: 2024-11 · check-in free text available
2022-06-05
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-06
Call 1 — Left Voicemail
2022-06-06
Call 1 — Left Voicemail
2022-06-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-12
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-19
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-26
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-15
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-18
Dose 5 — Moderna
Co-administered: Flu
2022-10-21
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Redness · None

Adult check-in
2022-10-22
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Redness · None

Adult check-in
2022-10-23
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Redness · None

Adult check-in
2022-10-24
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Redness · None

Adult check-in
2022-10-25
Health check-in — day 7, dose 5
Feeling: Good · Site: Redness · None

Adult check-in
2022-11-01
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-08
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-15
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-22
Survey response — day 35, dose 5
MedDRA: Fatigue, Laboratory test abnormal, Nasopharyngitis — Feeling: Good

Free text: Just a cold and tired Husband and I both had colds. Tested positive then next day we tested negative so not sure which to believe. Feel fine now

MedDRA releases: 2024-11 · check-in free text available
2022-11-29
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-17
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-18
Survey response — 6 months, dose 5
MedDRA: Nasopharyngitis, Respiratory tract congestion — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-18
Report sent to call center — 6 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-19
Call 1 — Left Voicemail
2023-04-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna
3	2021-09-10	Moderna	No
4	2022-05-15	Moderna	No
5	2022-10-18	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2022-03-12	Successful 2022-03-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-05	Successful 2022-06-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-18	Successful 2023-04-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 9 — 3 months, dose 2

2021-06-11

Symptoms: Fatigue and muscle pain

Release 11 — 12 months, dose 2

2022-03-12

Symptoms: Allergic reaction, tachycardia, pulmonary nodules

Release 11 — days 1–6 daily, dose 4

2022-05-17

Systemic reaction (other): Higher resting pulse

2022-05-19

Systemic reaction (other): Intermittent buzzing not tingling lasting one to two seconds up and down vaccinated arm several times daily since received shot.

Release 11 — day 21, dose 4

2022-06-05

Symptoms: Abscess tooth probably not related

Healthcare visit (other): Dentist

Release 12 — day 35, dose 5

2022-11-22

Symptoms: Just a cold and tired Husband and I both had colds. Tested positive then next day we tested negative so not sure which to believe. Feel fine now

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	Office visit	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Hypersensitivity	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Pulmonary mass	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Tachycardia	·	·	✓
SD	Tooth abscess	·	·	✓
SRO	Heart rate increased	·	·	✓
SRO	Paraesthesia	·	·	✓

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