ZER-21773-88721

3 vaccinations 8 coded responses 27 check-ins 8 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 945 / CA
Registered: 2021-01-04

Relationship: Self
Race: Other
Ethnicity: N/A

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-04
Survey response — day 0, dose 1
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: Fatigue less than 3 hours

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-05
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Pain at injection site only if I touch, otherwise non apparent

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-04
Dose 2 — Moderna
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Headache, Nausea — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Had headache, chills, nausea 12 hours post administration. Lasted 24 hours.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-08
Survey response — 3 months, dose 2
MedDRA: Bronchitis, Sinusitis, Unevaluable event — Feeling: Good · Be unable to work, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Bronchitis, sinusitis, sinus infection, thought it was allergies per se · Healthcare visit (other): Augmentin course

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Report sent to call center — 3 months, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-05
Survey response — 6 months, dose 2
MedDRA: Squamous cell carcinoma of skin — Feeling: Good

Free text: Squamous cell skin CA

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-28
Dose 3 — Moderna
Co-administered: Flu
2021-10-25
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-10-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-09
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-28
Survey response — 3 months, dose 3
MedDRA: Cough, Dyspnoea, Fatigue, Headache, Paranasal sinus discomfort, Paranasal sinus hypersecretion — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Shortness of breath, coughing, increased albuterol use, fatigue, sinus pressure, headache, sinus discharge, sinus infection?

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-29
Call 1 — Left Voicemail
2022-03-31
Survey response — 6 months, dose 3
MedDRA: Dysphonia, Pre-existing disease, Sinusitis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Ongoing allergies, persistent sinus infections , voice issues require speech therapy referral

MedDRA releases: 2024-11 · check-in free text available
2022-03-31
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)
2022-04-04
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-09-28
Survey response — 12 months, dose 3
MedDRA: Pre-existing disease, Vocal cord disorder — Feeling: Good

Free text: Need sinus surgery and procedure for vocal cords pending 10/11/22. vocal cords not closing. Multiple sinus infections and antibiotic history

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-04	Moderna
3	2021-09-28	Moderna	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-05-08	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-28	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-31	Successful 2022-04-04	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 1 — day 0, dose 1

2021-01-04

Systemic reaction (other): Fatigue less than 3 hours

Release 1 — days 1–6 daily, dose 1

2021-01-05

Systemic reaction (other): Pain at injection site only if I touch, otherwise non apparent

Release 3 — days 1–6 daily, dose 2

2021-02-08

Systemic reaction (other): Had headache, chills, nausea 12 hours post administration. Lasted 24 hours.

Release 8 — 3 months, dose 2

2021-05-08

Symptoms: Bronchitis, sinusitis, sinus infection, thought it was allergies per se

Healthcare visit (other): Augmentin course

Release 9 — 6 months, dose 2

2021-08-05

Symptoms: Squamous cell skin CA

Release 10 — 3 months, dose 3

2021-12-28

Symptoms: Shortness of breath, coughing, increased albuterol use, fatigue, sinus pressure, headache, sinus discharge, sinus infection?

Release 11 — 6 months, dose 3

2022-03-31

Symptoms: Ongoing allergies, persistent sinus infections , voice issues require speech therapy referral

Release 12 — 12 months, dose 3

2022-09-28

Symptoms: Need sinus surgery and procedure for vocal cords pending 10/11/22. vocal cords not closing. Multiple sinus infections and antibiotic history

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	Unevaluable event	✓	✓	✓
SD	Bronchitis	✓	✓	✓
SD	Cough	·	·	✓
SD	Dysphonia	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Paranasal sinus discomfort	·	·	✓
SD	Paranasal sinus hypersecretion	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sinusitis	✓	✓	✓
SD	Squamous cell carcinoma of skin	✓	·	✓
SD	Vocal cord disorder	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Nausea	✓	✓	✓

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