ZFE-30741-17463

2 vaccinations 8 coded responses 25 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 492 / MI
Registered: 2021-03-24

Relationship: Self
Race: N/A
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-24
Registered in v-safe
2021-03-24
Dose 1 — Moderna
2021-03-24
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Abdominal pain

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-31
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-14
Survey response — day 21, dose 1
MedDRA: Abdominal discomfort, Headache — Feeling: Fair

Free text: Could be old age! The last couple days Ive had a headache and intestinal distress. Probably not the vaccine, but just reporting it

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Dose 2 — Moderna
2021-04-21
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Good · Nausea

Free text: For the record I just got the shot an hour ago! So not sure how valid these responses are

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Survey response — days 1–6 daily, dose 2
MedDRA: Aphthous ulcer — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Canker sore in mouth. Probably not related but it just appeared last night

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Actually I had the fever yesterday but I didnt take it until after I had checked in. So please enter it for yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Survey response — days 1–6 daily, dose 2
MedDRA: Aphthous ulcer, Oral herpes, Self-medication — Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Free text: Still have fever blister/canker sore inside lower lip . Appeared day after shot. Not getting better in spite of Anbesol

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Aphthous ulcer, Hypoaesthesia, Lip swelling, Periorbital swelling, Swelling face — Feeling: Fair · Be unable to do your normal daily activities

Free text: I reported the canker sore that emerged the morning after my shot, I had been biting my lip in my sleep. Apparently my lip was swollen it is gotten increasingly swollen now it is so swollen it looks like someone punched me and I have trouble drinking. Also some numbness and swelling around my eye and cheek

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — days 1–6 daily, dose 2
MedDRA: Cheilitis, Eye swelling, Lip swelling, Self-medication, Swelling face — Feeling: Fair · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Swollen lips with rash at edges. Mostly on the left side. Sone swelling in cheek and around eye · Healthcare visit (other): They said to go to the emergency room. That us ridiculous. Its been like this for 3 days. I took a benedryl and some acetaminophen

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-28
Survey response — day 7, dose 2
MedDRA: Lip swelling, Pruritus — Feeling: Good

Free text: Lips still slightly swollen. Now itchy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-21
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-26
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-02
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-23
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-07
Call 1 — Left Voicemail
2022-04-07
Call successful
Participant prefers to complete VAERS report online
2022-04-23
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-24	Moderna
2	2021-04-21	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-26	Successful 2022-04-07	Participant prefers to complete VAERS report online

Free text

Release 7 — day 21, dose 1

2021-04-14

Symptoms: Could be old age! The last couple days Ive had a headache and intestinal distress. Probably not the vaccine, but just reporting it

Release 7 — day 0, dose 2

2021-04-21

Systemic reaction (other): For the record I just got the shot an hour ago! So not sure how valid these responses are

Release 7 — days 1–6 daily, dose 2

2021-04-22

Systemic reaction (other): Canker sore in mouth. Probably not related but it just appeared last night

2021-04-23

Systemic reaction (other): Actually I had the fever yesterday but I didnt take it until after I had checked in. So please enter it for yesterday

2021-04-24

Systemic reaction (other): Still have fever blister/canker sore inside lower lip . Appeared day after shot. Not getting better in spite of Anbesol

2021-04-25

Systemic reaction (other): I reported the canker sore that emerged the morning after my shot, I had been biting my lip in my sleep. Apparently my lip was swollen it is gotten increasingly swollen now it is so swollen it looks like someone punched me and I have trouble drinking. Also some numbness and swelling around my eye and cheek

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): Swollen lips with rash at edges. Mostly on the left side. Sone swelling in cheek and around eye

Healthcare visit (other): They said to go to the emergency room. That us ridiculous. Its been like this for 3 days. I took a benedryl and some acetaminophen

Release 8 — day 7, dose 2

2021-04-28

Systemic reaction (other): Lips still slightly swollen. Now itchy

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	Self-medication	✓	✓	✓
SD	Abdominal discomfort	✓	✓	✓
SD	Headache	✓	✓	✓
SRO	Aphthous ulcer	✓	✓	✓
SRO	Cheilitis	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Lip swelling	✓	✓	✓
SRO	Oral herpes	✓	✓	✓
SRO	Periorbital swelling	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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