ZC5-19561-47981

4 vaccinations 14 coded responses 39 check-ins 13 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 570 / SD
Registered: 2021-03-05

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
2021-03-05
Registered in v-safe
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Blood glucose decreased — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: I dont know if this is diet or not but my blood sugars are really down lower than normal.

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

Free text: Gassy. No diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Flatulence — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Still gassy

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

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

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Survey response — day 21, dose 1
MedDRA: Nasal inflammation — Feeling: Good

Free text: Noticed sinus inflamation on right side where i got my shot. It was there last week but i didnt mention it. After thinking of it, i thot i should mention it. Not infected. Just inflammed.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Dose 2 — Moderna
2021-04-01
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain, Flatulence — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work

Free text: Gas is abdominal pain

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

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain — Feeling: Fair · Fatigue or tiredness

Free text: Sore throat. May not be related

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
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
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-30
Survey response — 6 months, dose 2
MedDRA: Pre-existing disease — Feeling: Good

Free text: Allergies

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Dose 3 — Moderna
2022-04-03
Survey response — 12 months, dose 2
MedDRA: Tooth extraction, Tooth infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Unrelated to Covid shot, tooth extracted and infected.

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Dose 4 — Moderna
2022-05-20
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-05-21
Survey response — days 1–6 daily, dose 4
MedDRA: Blood glucose decreased, Hypersomnia — Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Slept 10 hours. Weird thing is my blood sugars are lower than i expected today.

MedDRA releases: 2024-11 · check-in free text available
2022-05-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fatigue or tiredness

Adult check-in
2022-05-25
Survey response — days 1–6 daily, dose 4
MedDRA: Vertigo — Feeling: Good · Site: Pain, Itching · Headache

Free text: Had vertigo but dont think its connected.

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Survey response — day 7, dose 4
MedDRA: Fatigue, Pre-existing disease — Feeling: Good · Site: Pain, Redness

Free text: Tired but not fatiqued. Notice slight vertigo but i have had that before.

MedDRA releases: 2024-11 · check-in free text available
2022-06-03
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-10
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-17
Survey response — day 28, dose 4
MedDRA: Fatigue, Pre-existing disease, Respiratory tract congestion — Feeling: Fair

Free text: Probably allergies. Stuffy and fatiqued.

MedDRA releases: 2024-11 · check-in free text available
2022-06-24
Survey response — day 35, dose 4
MedDRA: Fall — Feeling: Fair · Be unable to do your normal daily activities

Free text: Not related to covid shot. Has accidental fall

MedDRA releases: 2024-11 · check-in free text available
2022-07-01
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-19
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-21
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-20
Survey response — 12 months, dose 4
MedDRA: Angioplasty, Arterial occlusive disease, Surgery — 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

MedDRA releases: 2024-11
2023-05-20
Report sent to call center — 12 months, dose 4
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 · 1 call case(s)
2023-05-23
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Moderna
2	2021-04-01	Moderna
3	2021-10-15	Moderna	No
4	2022-05-20	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2023-05-20	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-06

Systemic reaction (other): I dont know if this is diet or not but my blood sugars are really down lower than normal.

2021-03-07

Systemic reaction (other): Gassy. No diarrhea

2021-03-08

Systemic reaction (other): Still gassy

Release 6 — day 21, dose 1

2021-03-25

Symptoms: Noticed sinus inflamation on right side where i got my shot. It was there last week but i didnt mention it. After thinking of it, i thot i should mention it. Not infected. Just inflammed.

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): Gas is abdominal pain

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Sore throat. May not be related

Release 9 — 6 months, dose 2

2021-09-30

Symptoms: Allergies

Release 11 — 12 months, dose 2

2022-04-03

Symptoms: Unrelated to Covid shot, tooth extracted and infected.

Release 11 — days 1–6 daily, dose 4

2022-05-21

Systemic reaction (other): Slept 10 hours. Weird thing is my blood sugars are lower than i expected today.

2022-05-25

Systemic reaction (other): Had vertigo but dont think its connected.

Release 11 — day 7, dose 4

2022-05-27

Systemic reaction (other): Tired but not fatiqued. Notice slight vertigo but i have had that before.

Release 12 — day 28, dose 4

2022-06-17

Symptoms: Probably allergies. Stuffy and fatiqued.

Release 12 — day 35, dose 4

2022-06-24

Symptoms: Not related to covid shot. Has accidental fall

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	Surgery	·	·	✓
SD	Angioplasty	·	·	✓
SD	Arterial occlusive disease	·	·	✓
SD	Fall	·	·	✓
SD	Fatigue	·	·	✓
SD	Nasal inflammation	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Tooth extraction	·	·	✓
SD	Tooth infection	·	·	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Blood glucose decreased	✓	✓	✓
SRO	Fatigue	·	·	✓
SRO	Flatulence	✓	✓	✓
SRO	Hypersomnia	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pre-existing disease	·	·	✓
SRO	Vertigo	·	·	✓

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