ZB4-24905-94767

2 vaccinations 11 coded responses 19 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 481 / MI
Registered: 2021-03-13

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

2021-03-04
Dose 1 — Moderna
2021-03-13
Registered in v-safe
2021-03-13
Survey response — day 7, dose 1
MedDRA: Chills, Pyrexia — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Free text: received severe chills & fever 5:00 a.m. March 5,2021

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Moderna
2021-04-01
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good

Free text: Nothing so far; its 5:15

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Sleep disorder — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: So far not as severe as reactions to first shot. But put hands on heating pad last night finally went to bed after 3 am. Up & down every couple hours used electric blanket to help with chills. Finally got out of bed around 2 today had some toast & chicken broth.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — days 1–6 daily, dose 2
MedDRA: Chills — Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness

Free text: Chills not lasting or serious.

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

Free text: Just still tired & weak!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Diarrhoea, Gastric disorder — Feeling: Good

Free text: Ive had diarrhea off & on for two weeks so havent considered it a side effect of the shot but thought I should mention it in case the shot extended it. I have stomach problems usually & think it is a separate issue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Have other issues I dont think shot related. Re: shot feel good just tired!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Gastric disorder — Feeling: Good

Free text: Just stomach issues after eating; dont think related to shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — day 7, dose 2
MedDRA: Diarrhoea — Feeling: Good

Free text: Loose bowels but think it's from medications

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-01
Survey response — 3 months, dose 2
MedDRA: COVID-19, Office visit, Thrombosis, Vascular cauterisation — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Had stool test blood; had EGD & Colonostomy biopsy negative on mass of blood vessels lining that dr cauterized. Scheduled for Small Bowel Capsule test 7/12. · Healthcare visit (other): Many dr appts & procedures done see above boxed answer. Vaccinations did not cause problems but having covid & blood clots did.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-01
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-06
Call 1 — Left Voicemail
2021-07-07
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-03
Survey response — 12 months, dose 2
MedDRA: Adverse reaction, Hospitalisation, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Problems been having since April 2021. Vsafe never contacted me re: shot and/or booster shot can't remember but was disappointed. · Healthcare visit (other): Go to drs regularly since hospitalization 4/1/2020.

MedDRA releases: 2024-11 · check-in free text available
2022-04-03
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Moderna
2	2021-04-01	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-07-01	Successful 2021-07-07	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-03	Unsuccessful

Free text

Release 5 — day 7, dose 1

2021-03-13

Systemic reaction (other): received severe chills & fever 5:00 a.m. March 5,2021

Release 6 — day 0, dose 2

2021-04-01

Systemic reaction (other): Nothing so far; its 5:15

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): So far not as severe as reactions to first shot. But put hands on heating pad last night finally went to bed after 3 am. Up & down every couple hours used electric blanket to help with chills. Finally got out of bed around 2 today had some toast & chicken broth.

2021-04-03

Systemic reaction (other): Chills not lasting or serious.

2021-04-04

Systemic reaction (other): Just still tired & weak!

2021-04-05

Systemic reaction (other): Ive had diarrhea off & on for two weeks so havent considered it a side effect of the shot but thought I should mention it in case the shot extended it. I have stomach problems usually & think it is a separate issue.

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Have other issues I dont think shot related. Re: shot feel good just tired!

2021-04-07

Systemic reaction (other): Just stomach issues after eating; dont think related to shot.

Release 7 — day 7, dose 2

2021-04-08

Systemic reaction (other): Loose bowels but think it's from medications

Release 9 — 3 months, dose 2

2021-07-01

Symptoms: Had stool test blood; had EGD & Colonostomy biopsy negative on mass of blood vessels lining that dr cauterized. Scheduled for Small Bowel Capsule test 7/12.

Healthcare visit (other): Many dr appts & procedures done see above boxed answer. Vaccinations did not cause problems but having covid & blood clots did.

Release 11 — 12 months, dose 2

2022-04-03

Symptoms: Problems been having since April 2021. Vsafe never contacted me re: shot and/or booster shot can't remember but was disappointed.

Healthcare visit (other): Go to drs regularly since hospitalization 4/1/2020.

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	Hospitalisation	·	·	✓
HCVO	Office visit	✓	✓	✓
HCVO	Thrombosis	✓	✓	✓
SD	Adverse reaction	·	·	✓
SD	Vascular cauterisation	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Gastric disorder	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓

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