ZGE-10884-02776

5 vaccinations 14 coded responses 37 check-ins 14 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 080 / NJ
Registered: 2021-01-26

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

2021-01-26
Registered in v-safe
2021-01-26
Dose 1 — Moderna
2021-01-26
Survey response — day 0, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Soreness at and near injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Dyskinesia, Injection site pain — Feeling: Good · Site: Pain · Muscle or body aches · Be unable to do your normal daily activities

Free text: Pain around injection site kept me up all night and limits my ability to raise the arm above my head and to lift heavy objects.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Slight soreness near injection remains, but much better than yesterday which upon reflection was moderate to severe.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-23
Dose 2 — Moderna
2021-02-23
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness, Headache, Impaired driving ability, Loss of consciousness, Loss of personal independence in daily activities, Malaise, Syncope — Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: I lost consciousness 2X when I got out of bed. I was woozy for hours and after fainting 2x afraid to get out of bed again. I was too sick to get in car to drive to doctor or call doctor. It is now almost 27 hours after I received my second COVID vaccine and I am starting to feel better. I am still very headachy and a bit unsteady on my feet, but I can concentrate enough now to fill out this form.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Dizziness, Headache — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Dizziness and very weak. I am retired, so I don't work. But if I worked, I would not have been able to work the past 2 days. This afternoon the headache and dizziness have dissipated and I was finally able to eat toast and drink tea.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — days 1–6 daily, dose 2
MedDRA: Headache — Feeling: Good · Site: Pain

Free text: Slight headache starting in late afternoon (Friday).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Slight dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Headache — Feeling: Fair · Headache

Free text: Slight light headedness with headache at times.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Headache — Feeling: Fair · Headache

Free text: Persistent mild headache and lightheaded at times.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Survey response — day 7, dose 2
MedDRA: Dizziness, Medical counselling — Feeling: Poor · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Extremely lightheaded · Healthcare visit (other): I called my doctor's office and have scheduled a telehealth appointment for tomorrow morning and a full in person physical for March 30.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Report sent to call center — day 7, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-09
Survey response — day 14, dose 2
MedDRA: Dizziness, Headache — Feeling: Fair · 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

Free text: Headaches, lightheaded, dizziness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-16
Survey response — day 21, dose 2
MedDRA: Concussion, Dizziness, Headache, Loss of consciousness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Headaches, dizziness & lightheaded intermittently continue due to concussion sustained when I lost consciousness less than 24 hours after receiving my second covid vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-30
Survey response — day 35, dose 2
MedDRA: Diarrhoea, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe diarrhea · Healthcare visit (other): Visit to my internist at her office.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-06
Survey response — day 42, dose 2
MedDRA: Concussion, Dizziness, Headache, Loss of consciousness — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Headaches are more frequent and jump around to different locations on, in my head. · Healthcare visit (other): Have scheduled appointments with a neurologist and cardiologist concerning my headaches, light headed ness and my loss of consciousness and resulting concussion the morning after I received my second COVID vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-22
Dose 3 — Moderna
2022-01-20
Call successful
Participant prefers to complete VAERS report online
2022-02-25
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-03-31
Dose 4 — Moderna
2022-04-29
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-05
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-12
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-01
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-09
Dose 5 — Moderna
2022-09-29
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-02
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-07
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-14
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-10-23
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-09
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-10
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-02-23	Moderna
3	2021-10-22	Moderna	No
4	2022-03-31	Moderna	No
5	2022-09-09	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-02	Successful	Participant prefers to complete VAERS report online
2021-03-09	Successful	Participant prefers to complete VAERS report online
2021-03-30	Successful	Participant prefers to complete VAERS report online
2021-04-06	Successful 2022-01-20	Participant prefers to complete VAERS report online

Free text

Release 2 — day 0, dose 1

2021-01-26

Systemic reaction (other): Soreness at and near injection site.

Release 2 — days 1–6 daily, dose 1

2021-01-27

Systemic reaction (other): Pain around injection site kept me up all night and limits my ability to raise the arm above my head and to lift heavy objects.

Release 3 — days 1–6 daily, dose 1

2021-01-28

Systemic reaction (other): Slight soreness near injection remains, but much better than yesterday which upon reflection was moderate to severe.

Release 4 — days 1–6 daily, dose 2

2021-02-24

Systemic reaction (other): I lost consciousness 2X when I got out of bed. I was woozy for hours and after fainting 2x afraid to get out of bed again. I was too sick to get in car to drive to doctor or call doctor. It is now almost 27 hours after I received my second COVID vaccine and I am starting to feel better. I am still very headachy and a bit unsteady on my feet, but I can concentrate enough now to fill out this form.

2021-02-25

Systemic reaction (other): Dizziness and very weak. I am retired, so I don't work. But if I worked, I would not have been able to work the past 2 days. This afternoon the headache and dizziness have dissipated and I was finally able to eat toast and drink tea.

2021-02-26

Systemic reaction (other): Slight headache starting in late afternoon (Friday).

2021-02-27

Systemic reaction (other): Slight dizziness

2021-02-28

Systemic reaction (other): Slight light headedness with headache at times.

2021-03-01

Systemic reaction (other): Persistent mild headache and lightheaded at times.

Release 4 — day 7, dose 2

2021-03-02

Systemic reaction (other): Extremely lightheaded

Healthcare visit (other): I called my doctor's office and have scheduled a telehealth appointment for tomorrow morning and a full in person physical for March 30.

Release 5 — day 14, dose 2

2021-03-09

Symptoms: Headaches, lightheaded, dizziness.

Release 5 — day 21, dose 2

2021-03-16

Symptoms: Headaches, dizziness & lightheaded intermittently continue due to concussion sustained when I lost consciousness less than 24 hours after receiving my second covid vaccine.

Release 6 — day 35, dose 2

2021-03-30

Symptoms: Severe diarrhea

Healthcare visit (other): Visit to my internist at her office.

Release 7 — day 42, dose 2

2021-04-06

Symptoms: Headaches are more frequent and jump around to different locations on, in my head.

Healthcare visit (other): Have scheduled appointments with a neurologist and cardiologist concerning my headaches, light headed ness and my loss of consciousness and resulting concussion the morning after I received my second COVID vaccine.

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	Concussion	✓	✓	✓
HCVO	Dizziness	✓	✓	✓
HCVO	Headache	✓	✓	✓
HCVO	Loss of consciousness	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
HCVO	Office visit	✓	✓	✓
SD	Concussion	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Loss of consciousness	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Balance disorder	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyskinesia	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Impaired driving ability	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Loss of consciousness	✓	✓	✓
SRO	Loss of personal independence in daily activities	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Syncope	✓	✓	✓

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