ZCB-28410-33066

3 vaccinations 19 coded responses 31 check-ins 19 free-text entries 8 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 840 / UT
Registered: 2021-01-06

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

2021-01-06
Registered in v-safe
2021-01-06
Dose 1 — Moderna
2021-01-06
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · Headache

Adult check-in
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-09
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-15
Survey response — day 7, dose 1
MedDRA: Arthritis, Pre-existing disease — Feeling: Poor · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Severe arthritis flare-everything hurts

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — day 7, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-20
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-01-27
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-03
Dose 2 — Moderna
2021-02-03
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Swelling · Headache

Free text: No

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

Free text: Sore throat, frequent urination, difficulty sleeping

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Bone pain, Oropharyngeal pain, Pain in extremity — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Sore throat, bone pain in legs

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Bone pain, Oropharyngeal pain — Feeling: Fair · Site: Pain · Headache, Abdominal pain

Free text: Sore throat, bone pain (not in joints)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain — Feeling: Good · Headache

Free text: Mild sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Bone pain, Oropharyngeal pain — Feeling: Good · Headache, Abdominal pain

Free text: Sore throat, bone pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — day 7, dose 2
MedDRA: Oropharyngeal pain — Feeling: Good · Headache, Fatigue or tiredness

Free text: Mild sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 14, dose 2
MedDRA: Fatigue, Feeling abnormal, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sore muscles, brain fog, worsening fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Survey response — day 21, dose 2
MedDRA: Chills, Fatigue, Pyrexia — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Chills, mild fever, severe fatigue

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

Adult check-in
2021-03-09
Call 1 — Left Voicemail
2021-03-10
Survey response — day 35, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: Worsening fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-09
Survey response — 3 months, dose 2
MedDRA: Axillary pain — 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

Free text: Persistent pain under left armpit for past 6 weeks. Lymph nodes are normal and nothing abnormal can be seen in an ultrasound.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-18
Call 1 — Left Voicemail
2021-08-06
Survey response — 6 months, dose 2
MedDRA: Coagulopathy, Cough, Dyspnoea, Emergency care, Fibrin D dimer increased, Palpitations — Feeling: Poor · 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

Free text: Some sort of abnormal clotting process (positive d-dimer test at ER), difficulty breathing, heart palpitations, cough.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-06
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)
2021-08-16
Call 1 — Left Voicemail
2021-10-01
Dose 3 — Moderna
2021-10-24
Survey response — day 21, dose 3
MedDRA: Pruritus, Stomatitis — 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

Free text: Mouth sores, extremely itchy skin

MedDRA releases: 2024-11 · check-in free text available
2021-10-24
Report sent to call center — day 21, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-26
Call 2 — Left Voicemail
2021-10-29
Survey response — day 28, dose 3
MedDRA: Fatigue, Pain in jaw — Feeling: Fair

Free text: Worsening fatigue, pain under my left jaw

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Health check-in — day 35, dose 3
Feeling: Poor

Adult check-in
2021-11-13
Health check-in — day 42, dose 3
Feeling: Poor

Adult check-in
2022-01-04
Survey response — 3 months, dose 3
MedDRA: Mouth ulceration — Feeling: Poor · 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: Reoccurring mouth ulcers

MedDRA releases: 2024-11 · check-in free text available
2022-01-04
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-01-06
Call 1 — Left Voicemail
2022-04-02
Survey response — 6 months, dose 3
MedDRA: Rash, Sensitive skin — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Rashes and skin sensitivity

MedDRA releases: 2024-11 · check-in free text available
2022-04-02
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-05
Call 1 — Left Voicemail
2022-10-03
Survey response — 12 months, dose 3
MedDRA: Abnormal loss of weight, Gastritis, Impaired gastric emptying, Pre-existing disease, Renal injury, Systemic lupus erythematosus — Feeling: Poor · 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: Lupus, gastroparesis, gastritis, kidney damage, unintentional weight loss, chronic nausea, chronic fevers

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-04
Call 1 — Left Voicemail
2022-10-04
Call 2 — Left Voicemail
2022-10-04
Call 2 — Left Voicemail
2022-10-04
Call 2 — Left Voicemail
2022-10-04
Call 1 — Left Voicemail
2022-10-04
Call 2 — Left Voicemail
2022-10-04
Call 2 — Left Voicemail
2022-10-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-06	Moderna
2	2021-02-03	Moderna
3	2021-10-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-09	Unsuccessful
2021-01-15	Unsuccessful
2021-05-09	Unsuccessful
2021-08-06	Unsuccessful
2021-10-24	Unsuccessful
2022-01-04	Unsuccessful
2022-04-02	Unsuccessful
2022-10-03	Unsuccessful

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-09

Systemic reaction (other): Sore throat

Release 2 — day 7, dose 1

2021-01-15

Systemic reaction (other): Severe arthritis flare-everything hurts

Release 3 — day 0, dose 2

2021-02-03

Systemic reaction (other): No

Release 3 — days 1–6 daily, dose 2

2021-02-04

Systemic reaction (other): Sore throat, frequent urination, difficulty sleeping

2021-02-05

Systemic reaction (other): Sore throat, bone pain in legs

2021-02-06

Systemic reaction (other): Sore throat, bone pain (not in joints)

2021-02-07

Systemic reaction (other): Mild sore throat

2021-02-09

Systemic reaction (other): Sore throat, bone pain

Release 4 — day 7, dose 2

2021-02-10

Systemic reaction (other): Mild sore throat

Release 4 — day 14, dose 2

2021-02-17

Symptoms: Sore muscles, brain fog, worsening fatigue

Release 4 — day 21, dose 2

2021-02-24

Symptoms: Chills, mild fever, severe fatigue

Release 5 — day 35, dose 2

2021-03-10

Symptoms: Worsening fatigue

Release 8 — 3 months, dose 2

2021-05-09

Symptoms: Persistent pain under left armpit for past 6 weeks. Lymph nodes are normal and nothing abnormal can be seen in an ultrasound.

Release 9 — 6 months, dose 2

2021-08-06

Symptoms: Some sort of abnormal clotting process (positive d-dimer test at ER), difficulty breathing, heart palpitations, cough.

Release 10 — day 21, dose 3

2021-10-24

Symptoms: Mouth sores, extremely itchy skin

Release 10 — day 28, dose 3

2021-10-29

Symptoms: Worsening fatigue, pain under my left jaw

Release 10 — 3 months, dose 3

2022-01-04

Symptoms: Reoccurring mouth ulcers

Release 11 — 6 months, dose 3

2022-04-02

Symptoms: Rashes and skin sensitivity

Release 12 — 12 months, dose 3

2022-10-03

Symptoms: Lupus, gastroparesis, gastritis, kidney damage, unintentional weight loss, chronic nausea, chronic fevers

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	Abnormal loss of weight	·	·	✓
SD	Axillary pain	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Coagulopathy	✓	·	✓
SD	Cough	✓	·	✓
SD	Dyspnoea	✓	·	✓
SD	Emergency care	✓	·	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Fibrin D dimer increased	✓	·	✓
SD	Gastritis	·	·	✓
SD	Impaired gastric emptying	·	·	✓
SD	Mouth ulceration	·	·	✓
SD	Myalgia	✓	✓	✓
SD	Pain in jaw	·	·	✓
SD	Palpitations	✓	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	·	·	✓
SD	Renal injury	·	·	✓
SD	Sensitive skin	·	·	✓
SD	Stomatitis	·	·	✓
SD	Systemic lupus erythematosus	·	·	✓
SRO	Arthritis	✓	✓	✓
SRO	Bone pain	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pollakiuria	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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