ZB4-22972-52591

3 vaccinations 7 coded responses 25 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 853 / AZ
Registered: 2021-03-03

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

2021-02-04
Dose 1 — Moderna
2021-03-03
Registered in v-safe
2021-03-04
Dose 2 — Moderna
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia, Self-medication — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Couldnt bring fever down with tylenol

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pruritus, Injection site swelling, Injection site warmth — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fever · Muscle or body aches

Free text: Area where I was injected is about 4+inches in diameter, raised, hot an itchy still 4th day after injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Fatigue or tiredness

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-04-03
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-13
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-04
Survey response — 3 months, dose 2
MedDRA: Computerised tomogram abnormal, Interstitial lung disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Not confirmed...see pulmonologist in two weeks. Only findings on CTInterstitial Lung Disease.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-14
Dose 3 — Moderna
2021-08-15
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-08-16
Survey response — days 1–6 daily, dose 3
MedDRA: Decreased appetite — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lack of appetite

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-17
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site reaction — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Extremely large injection site reaction. I am not exaggerating but it is in excess of 5 or six inches in diameter. I have a large arm.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-18
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · Fever · None

Adult check-in
2021-08-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-08-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness · None

Adult check-in
2021-08-22
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-08-29
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-09-06
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-09-14
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-09-26
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-11-13
Survey response — 3 months, dose 3
MedDRA: Kidney infection, Nephrolithiasis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Kidney infection. Kidney Stone

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-11-15
Call successful
Does not wish to fill out VAERS report
2022-02-12
Survey response — 6 months, dose 3
MedDRA: Kidney infection, Nephrolithiasis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Kidney infection and stone

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2021-08-14	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-11-13	Successful 2021-11-15	Does not wish to fill out VAERS report

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Couldnt bring fever down with tylenol

2021-03-07

Systemic reaction (other): Area where I was injected is about 4+inches in diameter, raised, hot an itchy still 4th day after injection.

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: Not confirmed...see pulmonologist in two weeks. Only findings on CTInterstitial Lung Disease.

Release 9 — days 1–6 daily, dose 3

2021-08-16

Systemic reaction (other): Lack of appetite

2021-08-17

Systemic reaction (other): Extremely large injection site reaction. I am not exaggerating but it is in excess of 5 or six inches in diameter. I have a large arm.

Release 10 — 3 months, dose 3

2021-11-13

Symptoms: Kidney infection. Kidney Stone

Release 11 — 6 months, dose 3

2022-02-12

Symptoms: Kidney infection and stone

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
SD	Computerised tomogram abnormal	✓	✓	✓
SD	Interstitial lung disease	✓	✓	✓
SD	Kidney infection	·	·	✓
SD	Nephrolithiasis	·	·	✓
SRO	Decreased appetite	✓	·	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Injection site reaction	✓	·	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Injection site warmth	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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