ZC5-80708-40587

2 vaccinations 6 coded responses 24 check-ins 6 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 731 / OK
Registered: 2021-02-26

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

2021-02-26
Registered in v-safe
2021-02-26
Dose 1 — Moderna
2021-02-26
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-02
Survey response — days 1–6 daily, dose 1
MedDRA: Ageusia — Feeling: Fair · Site: Swelling, Itching

Free text: Lost my sense of taste

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Good · Site: Itching

Free text: My sense of taste came back!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-04-09
Dose 2 — Moderna
2021-04-09
Survey response — day 0, dose 2
MedDRA: Injection site scab — Feeling: Good · Site: Itching

Free text: It seemed the injection site kept scabbing over (perhaps from the itching and scratching)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache · Be unable to do your normal daily activities

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache · Be unable to do your normal daily activities

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-04-16
Survey response — day 7, dose 2
MedDRA: Headache — Feeling: Good · Headache

Free text: Extremely mild headache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-11
Survey response — 3 months, dose 2
MedDRA: Ageusia, Anosmia, Back pain, Cough, Pneumonia, Pyrexia, SARS-CoV-2 test negative — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Completely lost sense of taste and smell.103Â° feverViolent coughMid-back pain Pneumonia · Healthcare visit (other): I am a patient of the (b)(6) Clinic and made an appt due to urgency. I was given 2 covid tests but one was treated incorrectly and a 2nd one given. The 2nd one was swabbed at the opening of my nostrils. Both negative.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-11
Report sent to call center — 3 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

1 call case(s)
2021-07-21
Call successful
Participant prefers to complete VAERS report online
2021-10-10
Survey response — 6 months, dose 2
MedDRA: Body temperature increased, Dehydration, Dizziness, Office visit, Rash, SARS-CoV-2 test negative — 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

Free text: Symptoms: Dizziness, dehydration, skin bumps, low grade temperature, negative Covid test (the quick test) · Healthcare visit (other): In-house clinic in (b)(6)

MedDRA releases: 2024-11 · check-in free text available
2021-10-10
Report sent to call center — 6 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

1 call case(s)
2021-10-12
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-09
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-26	Moderna
2	2021-04-09	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-07-11	Successful 2021-07-21	Participant prefers to complete VAERS report online
2021-10-10	Successful 2021-10-12	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 4 — days 1–6 daily, dose 1

2021-03-02

Systemic reaction (other): Lost my sense of taste

2021-03-03

Systemic reaction (other): My sense of taste came back!

Release 7 — day 0, dose 2

2021-04-09

Systemic reaction (other): It seemed the injection site kept scabbing over (perhaps from the itching and scratching)

Release 7 — day 7, dose 2

2021-04-16

Systemic reaction (other): Extremely mild headache.

Release 9 — 3 months, dose 2

2021-07-11

Symptoms: Completely lost sense of taste and smell.103Â° feverViolent coughMid-back pain Pneumonia

Healthcare visit (other): I am a patient of the (b)(6) Clinic and made an appt due to urgency. I was given 2 covid tests but one was treated incorrectly and a 2nd one given. The 2nd one was swabbed at the opening of my nostrils. Both negative.

redacted (b)(6)

Release 10 — 6 months, dose 2

2021-10-10

Symptoms: Dizziness, dehydration, skin bumps, low grade temperature, negative Covid test (the quick test)

Healthcare visit (other): In-house clinic in (b)(6)

redacted (b)(6)

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	SARS-CoV-2 test negative	✓	✓	✓
SD	Ageusia	✓	✓	✓
SD	Anosmia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Body temperature increased	·	·	✓
SD	Cough	✓	✓	✓
SD	Dehydration	·	·	✓
SD	Dizziness	·	·	✓
SD	Pneumonia	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Ageusia	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site scab	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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