Z9Y-80165-89261

2 vaccinations 9 coded responses 27 check-ins 9 free-text entries 8 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 515 / IA
Registered: 2020-12-21

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

2020-12-21
Registered in v-safe
2020-12-21
Dose 1 — Moderna
2020-12-21
Health check-in — day 0, dose 1
Feeling: Good · Chills

Adult check-in
2020-12-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2020-12-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2020-12-28
Health check-in — day 7, dose 1
Feeling: Good · Chills

Adult check-in
2021-01-04
Survey response — day 14, dose 1
MedDRA: Chills, Fatigue, Headache, Hypopnoea, Nasopharyngitis, Rhinorrhoea — Feeling: Fair · Be unable to work

Free text: Chills,exhaustion, headache, head cold, runny nose, shallow breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-04
Report sent to call center — day 14, dose 1
Be unable to work

1 call case(s)
2021-01-11
Survey response — day 21, dose 1
MedDRA: Dyspnoea, Lower respiratory tract infection — 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: Breathing difficulty and cold inside chest

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
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)
2021-01-18
Survey response — day 28, dose 1
MedDRA: Dyspnoea, Unevaluable event, X-ray — 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

Free text: Symptoms: Breathing difficulties · Healthcare visit (other): X-ray

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Report sent to call center — day 28, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-22
Dose 2 — Moderna
2021-01-22
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-01-29
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-14
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-21
Call 1 — Left Voicemail
2021-02-26
Survey response — day 35, dose 2
MedDRA: Dyspnoea, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Breathing is more difficult like it was in the beginning. Need inhaler. · Healthcare visit (other): Scheduled for Monday March 1st

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-05
Survey response — day 42, dose 2
MedDRA: Chest discomfort, Chest pain, Dyspnoea, Fatigue, Feeling cold, Feeling hot — 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

Free text: Chest pain that feels cold and tight, challenging breathing, tiredness, waves of feeling hot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-23
Survey response — 3 months, dose 2
MedDRA: Chest pain, Dyspnoea, Pain in extremity, Pulmonary mass — 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Breathing issues. Pain in arm and chest. Had ct scan found mass in lung.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Report sent to call center — 3 months, 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)
2021-06-17
Call 1 — Left Voicemail
2021-07-23
Survey response — 6 months, dose 2
MedDRA: Asthma, Fatigue — 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

Free text: Asthma developed. Then allergic reaction s to inhaler medicine. Fatigue.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-23
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)
2021-07-29
Call 1 — Left Voicemail
2022-01-22
Survey response — 12 months, dose 2
MedDRA: Dizziness, Fatigue — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, 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

Free text: Lightheaded deep fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-01-22
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-01-24
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-21	Moderna
2	2021-01-22	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-04	Unsuccessful
2021-01-11	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-01-18	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-02-26	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-03-05	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-04-23	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-07-23	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-22	Successful 2022-01-24	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 1 — day 14, dose 1

2021-01-04

Symptoms: Chills,exhaustion, headache, head cold, runny nose, shallow breathing

Release 1 — day 21, dose 1

2021-01-11

Symptoms: Breathing difficulty and cold inside chest

Release 2 — day 28, dose 1

2021-01-18

Symptoms: Breathing difficulties

Healthcare visit (other): X-ray

Release 3 — day 7, dose 2

2021-01-29

Systemic reaction (other): breathing

Release 4 — day 35, dose 2

2021-02-26

Symptoms: Breathing is more difficult like it was in the beginning. Need inhaler.

Healthcare visit (other): Scheduled for Monday March 1st

Release 5 — day 42, dose 2

2021-03-05

Symptoms: Chest pain that feels cold and tight, challenging breathing, tiredness, waves of feeling hot.

Release 7 — 3 months, dose 2

2021-04-23

Symptoms: Breathing issues. Pain in arm and chest. Had ct scan found mass in lung.

Release 9 — 6 months, dose 2

2021-07-23

Symptoms: Asthma developed. Then allergic reaction s to inhaler medicine. Fatigue.

Release 11 — 12 months, dose 2

2022-01-22

Symptoms: Lightheaded deep fatigue

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	✓	✓	✓
HCVO	Unevaluable event	·	·	✓
HCVO	X-ray	✓	✓	○
SD	Asthma	✓	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Dizziness	·	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling cold	✓	✓	✓
SD	Feeling hot	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypopnoea	✓	✓	✓
SD	Lower respiratory tract infection	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pulmonary mass	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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