ZA8-68514-13177

4 vaccinations 13 coded responses 26 check-ins 12 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 786 / TX
Registered: 2021-01-30

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

2021-01-30
Registered in v-safe
2021-01-30
Dose 1 — Moderna
2021-01-30
Survey response — day 0, dose 1
MedDRA: Injection site pain — Feeling: Good · Fatigue or tiredness

Free text: A little tenderness at sight and perhaps a little red about a dime size

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: Enuresis, Glossitis, Musculoskeletal stiffness, Swollen tongue, Urinary incontinence — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Last night I had an accident in bed . I was dreaming I went to the bathroom and I did . This has never happened before . It was only urine and it woke me up immediately but the blanket sheets and pad were wet. Slightly swollen tongue and irritated on the top slightly . Stiffer than normal neck .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — days 1–6 daily, dose 1
MedDRA: Bone pain — Feeling: Fair · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain down and up the long bones .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 1
MedDRA: Dry mouth, Glossitis, Oral mucosal erythema, Stomatitis, Tongue erythema — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: My tongue and inside my cheeks are still red and irritated . Still having some dry mouth .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — day 7, dose 1
MedDRA: Eye pruritus, Oral mucosal eruption, Pruritus, Rash — Feeling: Poor · Site: Itching · Headache, Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: I have rash everywhere . Even inside my mouth my vagina and Pubic area . My eyes itch my scalp my everywhere . Ive taken 3 Benadryl over 8 hours . I have taken a cool shower and used cortisone cream .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — day 14, dose 1
MedDRA: Contusion, Headache, Myalgia, Pain, Pruritus, Rash, Skin fissures, Stomatitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: I am still itching and have a fine rash all over my body .i have scratches in my sleep and have bruises up and down my arms and my legs and around my waist and under my arms . My head itches insideOf my mouth is irritated still . Headache muscle ac

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-27
Survey response — day 28, dose 1
MedDRA: Arthralgia, Myalgia — Feeling: Good

Free text: Muscle and joint pains still in neck, shoulders and legs .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Dose 2 — Moderna
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Disorientation, Headache, Pain in extremity — Feeling: Good · Site: Itching · Headache, Muscle or body aches · Be unable to work

Free text: 2nd day my arm was extremely painful .I could barely lift it . I felt disoriented and had chills. I had a headache and 1 time it was a headache that was searing behind my left eye .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-08
Health check-in — day 7, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-15
Survey response — day 14, dose 2
MedDRA: Headache, Neck pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headache and neck ache are horrible

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — day 21, dose 2
MedDRA: Diarrhoea, Fatigue, Headache — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Diarrhea, headache , fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-14
Survey response — day 42, dose 2
MedDRA: Amnesia, Headache, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: I cant seem to get y energy back or shake this mild to moderate headache .Also muscle aches. Some short term memory loss.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-15
Dose 3 — Moderna
Co-administered: Flu
2022-03-03
Survey response — 12 months, dose 2
MedDRA: Asthma, Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: My Asthma is worse this allergy season than it has ever been . Starting last November · Healthcare visit (other): Regular doctor too

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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-04
Call 1 — Left Voicemail
2022-05-11
Dose 4 — Moderna
2022-06-26
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-10
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-11-10
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-05-11
Survey response — 12 months, dose 4
MedDRA: Asthenia, Fall, Fatigue, Intervertebral disc compression, Intervertebral disc protrusion, Thoracic vertebral fracture — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-05-11
Report sent to call center — 12 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2023-05-12
Call 2 — Left Voicemail
2023-05-12
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-30	Moderna
2	2021-03-01	Moderna
3	2021-11-15	Moderna	Flu
4	2022-05-11	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-03-03	Unsuccessful
2023-05-11	Unsuccessful

Free text

Release 3 — day 0, dose 1

2021-01-30

Systemic reaction (other): A little tenderness at sight and perhaps a little red about a dime size

Release 3 — days 1–6 daily, dose 1

2021-01-31

Systemic reaction (other): Last night I had an accident in bed . I was dreaming I went to the bathroom and I did . This has never happened before . It was only urine and it woke me up immediately but the blanket sheets and pad were wet. Slightly swollen tongue and irritated on the top slightly . Stiffer than normal neck .

2021-02-01

Systemic reaction (other): Pain down and up the long bones .

2021-02-05

Systemic reaction (other): My tongue and inside my cheeks are still red and irritated . Still having some dry mouth .

Release 3 — day 7, dose 1

2021-02-06

Systemic reaction (other): I have rash everywhere . Even inside my mouth my vagina and Pubic area . My eyes itch my scalp my everywhere . Ive taken 3 Benadryl over 8 hours . I have taken a cool shower and used cortisone cream .

Release 4 — day 14, dose 1

2021-02-13

Symptoms: I am still itching and have a fine rash all over my body .i have scratches in my sleep and have bruises up and down my arms and my legs and around my waist and under my arms . My head itches insideOf my mouth is irritated still . Headache muscle ac cut off by CDC

Release 4 — day 28, dose 1

2021-02-27

Symptoms: Muscle and joint pains still in neck, shoulders and legs .

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): 2nd day my arm was extremely painful .I could barely lift it . I felt disoriented and had chills. I had a headache and 1 time it was a headache that was searing behind my left eye .

Release 5 — day 14, dose 2

2021-03-15

Symptoms: Headache and neck ache are horrible

Release 6 — day 21, dose 2

2021-03-22

Symptoms: Diarrhea, headache , fatigue

Release 7 — day 42, dose 2

2021-04-14

Symptoms: I cant seem to get y energy back or shake this mild to moderate headache .Also muscle aches. Some short term memory loss.

Release 11 — 12 months, dose 2

2022-03-03

Symptoms: My Asthma is worse this allergy season than it has ever been . Starting last November

Healthcare visit (other): Regular doctor too

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	Amnesia	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Asthenia	·	·	✓
SD	Asthma	·	·	✓
SD	Contusion	✓	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Fall	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Intervertebral disc compression	·	·	✓
SD	Intervertebral disc protrusion	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Pain	○	✓	○
SD	Pre-existing disease	·	·	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Skin fissures	○	✓	○
SD	Stomatitis	✓	✓	✓
SD	Thoracic vertebral fracture	·	·	✓
SRO	Bone pain	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Disorientation	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Enuresis	✓	·	✓
SRO	Eye pruritus	✓	✓	✓
SRO	Glossitis	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Musculoskeletal stiffness	✓	✓	✓
SRO	Oral mucosal eruption	✓	✓	✓
SRO	Oral mucosal erythema	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Stomatitis	✓	✓	✓
SRO	Swollen tongue	✓	✓	✓
SRO	Tongue erythema	✓	✓	✓
SRO	Urinary incontinence	○	✓	○

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