Z9Y-33117-67688

3 vaccinations 12 coded responses 23 check-ins 12 free-text entries 5 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 125 / NY
Registered: 2021-02-12

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-02-11
Dose 1 — Moderna
2021-02-12
Registered in v-safe
2021-02-12
Survey response — days 1–6 daily, dose 1
MedDRA: Medical counselling, Rash, Rash erythematous, Rash macular — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Hot Red Slap rash on face neck this morning turned to red splotches not itchy just hot slowly going away...? · Healthcare visit (other): Telephone consult PCP

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Report sent to call center — days 1–6 daily, 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)
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Hot flush, Rash, Rash macular — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Hot flash rash& splotches face neck chest mainly

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

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 — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-25
Survey response — day 14, dose 1
MedDRA: COVID-19, Musculoskeletal chest pain, Pulmonary pain, Pyrexia — 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

Free text: Symptoms: Temperature returned and I have pain in my right rib/lung area (started on 2/14/21 for no reason) and has progressed since - fever ran high 2/12/21-2/15/21(ish) then was lower but still above 100 for 2-3 days, as of 2/22-fever ret 101.8-2/26-100.1 · Healthcare visit (other): Covid XrayBloodworkUrine test

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
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)
2021-03-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-11
Dose 2 — Moderna
2021-03-11
Survey response — day 0, dose 2
MedDRA: Medical counselling, Unevaluable event — Feeling: Good · Fever · Be unable to work, Be unable to do your normal daily activities

Free text: UPSET OVER COUNTY ACTION ON SUPPLYING MY 2nd DOSE AT (b)(6) CONCERN FOR REACTION EVEN AFTER ALLOWING THE NURSE TO SPEAK WITH MY PERSONAL PHYSICIAN WHO GAVE ME THE APPROVAL AND RECOM. TO GET THE VAX TODAY- VACCINE &STATING I WAS UNABLE DUE TO CDC REG/GUIDELINES- WHICH IVE SINCE CONFIRMED AS UNTRUE! ),

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to do your normal daily activities

Free text: Swollen glands

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Body temperature increased, Pre-existing disease, Unevaluable event — Feeling: Fair · Site: Pain, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: PLEASE NOTE-I am an autoimmune disorder person- I have Rhuemetoid disease and inflammatory arthritis- the aches pains in my joints are probably bad because Im off of my treatment medications to have received the vax- my temp is norm most days at 99.9!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Hyperhidrosis, Nasopharyngitis, Rash — Feeling: Fair · Site: Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Rash on face/neck-left for a day this morning it reappeared on my face- it is spots- hot red itchy spots-reminds me of chickPox-on and off all over me but concentrate on face ! Extreme sweating then freezing- I think from temp rising and falling- worked today! Had no coverage

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-18
Health check-in — day 7, dose 2
Feeling: Good · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-25
Health check-in — day 14, dose 2
Feeling: Fair

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

Adult check-in
2021-04-11
Survey response — day 28, dose 2
MedDRA: Asthma, Condition aggravated, Hypersensitivity, Muscle spasms, Pre-existing disease, Unevaluable event, Wheezing — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe cramping- locking up from RD/RA disease flare? Call Doc Monday... ugh! I think its from the lag in medications - its on&off since 2nd vax...? Also major allergies? Seasonal? And asthma wheezing has increased??? More then ever before? S · Healthcare visit (other): Havent called will call Monday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-17
Survey response — day 35, dose 2
MedDRA: Lymphadenopathy, Oropharyngeal pain, Rash, Rash papular, Swollen tongue — Feeling: Good · Be unable to do your normal daily activities

Free text: Swollen lymph nodes neck both sides, slight raised rash legs, upper arms, for a few days on and off, bump on tongue, sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Survey response — day 42, dose 2
MedDRA: Pre-existing disease, Rheumatoid arthritis, Unevaluable event — Feeling: Good · 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: Symptoms: Major flare (inflammatory arthritis) RA- wrists& back · Healthcare visit (other): May see in person as well to follow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Report sent to call center — day 42, 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)
2021-06-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-04
Call 1 — Left Voicemail
2021-08-31
Dose 3 — Moderna
2021-09-09
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Headache, Medical counselling, Pain, Reaction to previous exposure to any vaccine, Unevaluable event, Urticaria — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Had boosted so I believe to be reaction again- hives temperature headaches sore achy body joints · Healthcare visit (other): Telephone

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

1 call case(s)
2021-09-13
Call 1 — Left Voicemail
2022-03-13
Survey response — 12 months, dose 2
MedDRA: Balance disorder, Dizziness, Hyperhidrosis, Tremor, Vomiting — Feeling: Poor · Be unable to do your normal daily activities

Free text: With any type of / slow to moderate continuing movement-( walking more than 20 feet, stairs, vacuuming , even with standing still doing dishes or anything slightly/vigorous- I become SUPER dizzy unsteady loss of balance Sweaty, vomit shaky- faint!) -

MedDRA releases: 2024-11 · check-in free text available
2022-08-31
Health check-in — 12 months, dose 3
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-11	Moderna
2	2021-03-11	Moderna
3	2021-08-31	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-12	Unsuccessful
2021-02-25	Unsuccessful
2021-04-11	Unsuccessful
2021-04-22	Unsuccessful
2021-09-09	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-12

Systemic reaction (other): Hot Red Slap rash on face neck this morning turned to red splotches not itchy just hot slowly going away...?

Healthcare visit (other): Telephone consult PCP

2021-02-13

Systemic reaction (other): Hot flash rash& splotches face neck chest mainly

Release 4 — day 14, dose 1

2021-02-25

Symptoms: Temperature returned and I have pain in my right rib/lung area (started on 2/14/21 for no reason) and has progressed since - fever ran high 2/12/21-2/15/21(ish) then was lower but still above 100 for 2-3 days, as of 2/22-fever ret 101.8-2/26-100.1

Healthcare visit (other): Covid XrayBloodworkUrine test

Release 5 — day 0, dose 2

2021-03-11

Systemic reaction (other): UPSET OVER COUNTY ACTION ON SUPPLYING MY 2nd DOSE AT (b)(6) CONCERN FOR REACTION EVEN AFTER ALLOWING THE NURSE TO SPEAK WITH MY PERSONAL PHYSICIAN WHO GAVE ME THE APPROVAL AND RECOM. TO GET THE VAX TODAY- VACCINE &STATING I WAS UNABLE DUE TO CDC REG/GUIDELINES- WHICH IVE SINCE CONFIRMED AS UNTRUE! ),

redacted (b)(6)

Release 5 — days 1–6 daily, dose 2

2021-03-13

Systemic reaction (other): Swollen glands

2021-03-14

Systemic reaction (other): PLEASE NOTE-I am an autoimmune disorder person- I have Rhuemetoid disease and inflammatory arthritis- the aches pains in my joints are probably bad because Im off of my treatment medications to have received the vax- my temp is norm most days at 99.9!

2021-03-15

Systemic reaction (other): Rash on face/neck-left for a day this morning it reappeared on my face- it is spots- hot red itchy spots-reminds me of chickPox-on and off all over me but concentrate on face ! Extreme sweating then freezing- I think from temp rising and falling- worked today! Had no coverage

Release 7 — day 28, dose 2

2021-04-11

Symptoms: Severe cramping- locking up from RD/RA disease flare? Call Doc Monday... ugh! I think its from the lag in medications - its on&off since 2nd vax...? Also major allergies? Seasonal? And asthma wheezing has increased??? More then ever before? S

Healthcare visit (other): Havent called will call Monday

Release 7 — day 35, dose 2

2021-04-17

Symptoms: Swollen lymph nodes neck both sides, slight raised rash legs, upper arms, for a few days on and off, bump on tongue, sore throat

Release 7 — day 42, dose 2

2021-04-22

Symptoms: Major flare (inflammatory arthritis) RA- wrists& back

Healthcare visit (other): May see in person as well to follow

Release 9 — 6 months, dose 2

2021-09-09

Symptoms: Had boosted so I believe to be reaction again- hives temperature headaches sore achy body joints

Healthcare visit (other): Telephone

Release 11 — 12 months, dose 2

2022-03-13

Symptoms: With any type of / slow to moderate continuing movement-( walking more than 20 feet, stairs, vacuuming , even with standing still doing dishes or anything slightly/vigorous- I become SUPER dizzy unsteady loss of balance Sweaty, vomit shaky- faint!) - cut off by CDC

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	COVID-19	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Asthma	✓	✓	✓
SD	Balance disorder	·	·	✓
SD	Condition aggravated	✓	✓	✓
SD	Dizziness	·	·	✓
SD	Headache	·	·	✓
SD	Hyperhidrosis	·	·	✓
SD	Hypersensitivity	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Musculoskeletal chest pain	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pulmonary pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash papular	✓	✓	✓
SD	Reaction to previous exposure to any vaccine	·	·	✓
SD	Rheumatoid arthritis	✓	✓	✓
SD	Swollen tongue	✓	✓	✓
SD	Tremor	·	·	✓
SD	Unevaluable event	·	·	✓
SD	Urticaria	·	·	✓
SD	Vomiting	·	·	✓
SD	Wheezing	✓	✓	✓
SRO	Arthralgia	✓	·	✓
SRO	Body temperature increased	✓	·	✓
SRO	Hot flush	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Medical counselling	✓	·	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash erythematous	✓	✓	✓
SRO	Rash macular	✓	✓	✓
SRO	Unevaluable event	○	✓	○

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