ZE2-41867-97444

4 vaccinations 5 coded responses 27 check-ins 4 free-text entries 3 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 494 / MI
Registered: 2021-02-12

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

2021-02-03
Dose 1 — Moderna
2021-02-12
Registered in v-safe
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-17
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-03
Dose 2 — Moderna
2021-03-03
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: Epistaxis — Feeling: Good · Chills

Free text: Not sure if related this long after my 2nd dose but Ive had really bad bloody nose several times over the past week, week & a half.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-01
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-18
Dose 3 — Moderna
2022-03-03
Survey response — 12 months, dose 2
MedDRA: Dyspnoea, Emergency care, Office visit, Pre-existing disease — Feeling: Poor · 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, Hospitalization

Free text: Extreme difficulty breathing. 02 levels are normal. I've been in the hospital & the doctors "think" the issue is related to the mast cell disorder that I have.

MedDRA releases: 2024-11 · check-in free text available
2022-03-03
Report sent to call center — 12 months, dose 2
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 · Hospitalization · 1 call case(s)
2022-03-04
Call successful
Does not wish to fill out VAERS report
2022-04-08
Dose 4 — Moderna
Co-administered: Shingles
2022-04-28
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-29
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-13
Survey response — day 35, dose 4
MedDRA: Cough, Laryngitis, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: Poor · Be unable to do your normal daily activities

Free text: I just think I have a bad cold or maybe allergies. I took a covid test (at home) and it was negative. I'm coughing, blowing my nose, sore throat and I have laryngitis.

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Survey response — day 42, dose 4
MedDRA: Dyspnoea, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Difficulty breathing & am now on oxygen during the day. Doctors are currently unsure if it's related to the mast cell disorder I have. Still being investigated.

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Report sent to call center — day 42, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-23
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-08
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-07
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-08
Survey response — 12 months, dose 4
MedDRA: Dyspnoea, Oxygen saturation decreased, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-04-08
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

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-04-10
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-03	Moderna
2	2021-03-03	Moderna
3	2021-11-18	Moderna	No
4	2022-04-08	Moderna	Shingles

Call center

Reported	Outcome	VAERS-related outcome
2022-03-03	Successful 2022-03-04	Does not wish to fill out VAERS report
2022-05-20	Successful 2022-05-23	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-08	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-09

Systemic reaction (other): Not sure if related this long after my 2nd dose but Ive had really bad bloody nose several times over the past week, week & a half.

Release 11 — 12 months, dose 2

2022-03-03

Symptoms: Extreme difficulty breathing. 02 levels are normal. I've been in the hospital & the doctors "think" the issue is related to the mast cell disorder that I have.

Release 11 — day 35, dose 4

2022-05-13

Symptoms: I just think I have a bad cold or maybe allergies. I took a covid test (at home) and it was negative. I'm coughing, blowing my nose, sore throat and I have laryngitis.

Release 11 — day 42, dose 4

2022-05-20

Symptoms: Difficulty breathing & am now on oxygen during the day. Doctors are currently unsure if it's related to the mast cell disorder I have. Still being investigated.

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	Cough	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Laryngitis	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Oxygen saturation decreased	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Epistaxis	✓	✓	✓

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