Z98-21213-72883

4 vaccinations 6 coded responses 26 check-ins 6 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 481 / MI
Registered: 2021-02-09

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

2021-02-09
Registered in v-safe
2021-02-09
Dose 1 — Moderna
2021-02-09
Health check-in — day 0, dose 1
Feeling: Good · Headache

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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 — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-02
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-10
Dose 2 — Moderna
2021-03-23
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-09
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-08
Survey response — 6 months, dose 2
MedDRA: Dizziness — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Dizziness, possible TIA

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

1 call case(s)
2021-09-14
Call successful
Does not wish to fill out VAERS report
2021-11-09
Dose 3 — Moderna
2022-03-10
Survey response — 12 months, dose 2
MedDRA: Blood electrolytes decreased, Blood potassium decreased, Blood sodium decreased, Cyanosis, Daydreaming, Dizziness, Dyspnoea, Transient ischaemic attack — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Dizziness, TIA, breathing difficulties, absent minded, cyanotic fingers, drop in electrolytes and potassium and dangerously low sodium.

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-11
Call successful
Participant prefers to complete VAERS report online
2022-04-05
Dose 4 — Moderna
2022-04-30
Survey response — day 21, dose 4
MedDRA: Blood electrolytes decreased, Blood potassium decreased, Blood sodium decreased, Dizziness, Fatigue, Skin discolouration, Sleep disorder, Transient ischaemic attack — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: TIA, dizziness, fingers turning purple, extreme fatigue, sleep disturbances, low potassium, low electrolytes, extremely low sodium

MedDRA releases: 2024-11 · check-in free text available
2022-04-30
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-03
Survey response — day 28, dose 4
MedDRA: Blood electrolytes decreased, Blood potassium decreased, Blood sodium decreased, Dizziness, Fatigue — 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, Emergency room or emergency department visit, Hospitalization

Free text: Various. Low potassium, low electrolytes, low sodium. Dizziness. Exhaustion

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Report sent to call center — day 28, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-03
Call successful
Does not wish to fill out VAERS report
2022-05-04
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-10
Survey response — day 35, dose 4
MedDRA: Fatigue, Office visit — 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: Symptoms: Exhaustion · Healthcare visit (other): ENT

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Report sent to call center — day 35, dose 4
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)
2022-05-11
Call successful
Does not wish to fill out VAERS report
2022-05-17
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-05
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-04
Survey response — 6 months, dose 4
MedDRA: Asthma, Blood iron decreased — Feeling: Good

Free text: Diagnosed with asthma and my iron is a little low.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-10	Moderna
3	2021-11-09	Moderna	No
4	2022-04-05	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-08	Successful 2021-09-14	Does not wish to fill out VAERS report
2022-03-10	Successful 2022-03-11	Participant prefers to complete VAERS report online
2022-04-30	Successful 2022-05-03	Does not wish to fill out VAERS report
2022-05-03	Successful 2022-05-04	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-10	Successful 2022-05-11	Does not wish to fill out VAERS report

Free text

Release 9 — 6 months, dose 2

2021-09-08

Symptoms: Dizziness, possible TIA

Release 11 — 12 months, dose 2

2022-03-10

Symptoms: Dizziness, TIA, breathing difficulties, absent minded, cyanotic fingers, drop in electrolytes and potassium and dangerously low sodium.

Release 11 — day 21, dose 4

2022-04-30

Symptoms: TIA, dizziness, fingers turning purple, extreme fatigue, sleep disturbances, low potassium, low electrolytes, extremely low sodium

Release 11 — day 28, dose 4

2022-05-03

Symptoms: Various. Low potassium, low electrolytes, low sodium. Dizziness. Exhaustion

Release 11 — day 35, dose 4

2022-05-10

Symptoms: Exhaustion

Healthcare visit (other): ENT

Release 12 — 6 months, dose 4

2022-10-04

Symptoms: Diagnosed with asthma and my iron is a little low.

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	Asthma	·	·	✓
SD	Blood electrolytes decreased	·	·	✓
SD	Blood iron decreased	·	·	✓
SD	Blood potassium decreased	·	·	✓
SD	Blood sodium decreased	·	·	✓
SD	Cyanosis	·	·	✓
SD	Daydreaming	·	·	✓
SD	Dizziness	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Skin discolouration	·	·	✓
SD	Sleep disorder	·	·	✓
SD	Transient ischaemic attack	·	·	✓

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