ZH7-10266-97173

5 vaccinations 9 coded responses 36 check-ins 8 free-text entries 7 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 460 / IN
Registered: 2021-01-03

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

2021-01-02
Dose 1 — Moderna
2021-01-03
Registered in v-safe
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-07
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 — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-23
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-30
Dose 2 — Moderna
2021-01-30
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: Thirst — Feeling: Good · Site: Pain · Fever · Chills, Fatigue or tiredness, Abdominal pain

Free text: Excessive thirst

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Fatigue or tiredness

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — day 7, dose 2
Feeling: Fair · Fever · Chills, Muscle or body aches, Fatigue or tiredness · 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

Adult check-in
2021-02-06
Report sent to call center — day 7, dose 2
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)
2021-02-13
Survey response — day 14, dose 2
MedDRA: Pyrexia, SARS-CoV-2 test negative, Self-medication — Feeling: Poor · Be unable to work, 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: Fever to 101 - resolves with Tylenol but returns every 6 hours. For 8 days straight now No other infection. Had tests that were normal so no other illness (including negative COVID test)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Report sent to call center — day 14, dose 2
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)
2021-02-20
Survey response — day 21, dose 2
MedDRA: Pneumonia — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: I was diagnosed with right upper lobe pneumonia on 2/15/21 (by chest x-ray).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-01
Survey response — 3 months, dose 2
MedDRA: Bronchoscopy, Crohn's disease, Organising pneumonia, Pneumonia bacterial, Pre-existing disease, Unevaluable event — Feeling: Poor · Be unable to work, 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: Symptoms: Cryptogenic Organizing Pneumonia - started (2/5/21) right after 2nd dose (1/30/21). Initially thought bacterial pneumonia but didnt resolve. Have Crohns Disease & on Humira so unsure if related to vaccine or those underlying conditions · Healthcare visit (other): Bronchoscopy 4/29/21

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Report sent to call center — 3 months, dose 2
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)
2021-07-16
Call 1 — Left Voicemail
2021-07-31
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Dose 3 — Moderna
2022-02-16
Dose 4 — Moderna
2022-02-16
Survey response — 6 months, dose 3
MedDRA: Blood magnesium decreased, Heart rate decreased — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Episodes of low heart rate - worse at night or after eating. Believed to be related to low magnesium levels

MedDRA releases: 2024-11 · check-in free text available
2022-02-16
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)
2022-02-21
Call 1 — Left Voicemail
2022-08-18
Survey response — 12 months, dose 3
MedDRA: Abscess, Crohn's disease, Fistula, Pre-existing disease, Surgery — Feeling: Good · 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, Hospitalization

Free text: Crohn's disease flare up with abscess & fistula requiring surgery on April 12, 2022 and May 23, 2022

MedDRA releases: 2024-11 · check-in free text available
2022-08-18
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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-08-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-19
Call successful
Not applicable - Accidental Reporting
2022-08-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-16
Dose 5 — Moderna
2022-09-17
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-09-19
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-09-20
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-09-21
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-09-22
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-09-23
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-09-30
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-09
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-14
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-21
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-10-28
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-18
Survey response — 3 months, dose 5
MedDRA: Abdominal pain, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Crohn's disease related abdominal pain

MedDRA releases: 2024-11 · check-in free text available
2022-12-18
Report sent to call center — 3 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-19
Call 1 — Left Voicemail
2023-03-19
Survey response — 6 months, dose 5
MedDRA: Abdominal abscess, Crohn's disease, Fistula — Feeling: Fair · 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, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-03-19
Report sent to call center — 6 months, dose 5
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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-03-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-02	Moderna
2	2021-01-30	Moderna
3	2021-08-16	Moderna	No
4	2022-02-16	Moderna	No
5	2022-09-16	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-06	Successful 2022-08-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-02-13	Successful 2022-08-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-05-01	Successful 2022-08-19	Not applicable - Accidental Reporting
2022-02-16	Successful 2022-08-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-18	Successful 2022-08-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-18	Successful 2023-03-20	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-03-19	Successful 2023-03-20	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — days 1–6 daily, dose 2

2021-01-31

Systemic reaction (other): Excessive thirst

2021-02-03

Systemic reaction (other): Dizzy

Release 4 — day 14, dose 2

2021-02-13

Symptoms: Fever to 101 - resolves with Tylenol but returns every 6 hours. For 8 days straight now No other infection. Had tests that were normal so no other illness (including negative COVID test)

Release 4 — day 21, dose 2

2021-02-20

Symptoms: I was diagnosed with right upper lobe pneumonia on 2/15/21 (by chest x-ray).

Release 8 — 3 months, dose 2

2021-05-01

Symptoms: Cryptogenic Organizing Pneumonia - started (2/5/21) right after 2nd dose (1/30/21). Initially thought bacterial pneumonia but didnt resolve. Have Crohns Disease & on Humira so unsure if related to vaccine or those underlying conditions

Healthcare visit (other): Bronchoscopy 4/29/21

Release 11 — 6 months, dose 3

2022-02-16

Symptoms: Episodes of low heart rate - worse at night or after eating. Believed to be related to low magnesium levels

Release 12 — 12 months, dose 3

2022-08-18

Symptoms: Crohn's disease flare up with abscess & fistula requiring surgery on April 12, 2022 and May 23, 2022

Release 12 — 3 months, dose 5

2022-12-18

Symptoms: Crohn's disease related abdominal pain

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	Bronchoscopy	○	✓	○
HCVO	Unevaluable event	✓	·	✓
SD	Abdominal abscess	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Abscess	·	·	✓
SD	Blood magnesium decreased	·	·	✓
SD	Crohn's disease	○	✓	✓
SD	Fistula	·	·	✓
SD	Heart rate decreased	·	·	✓
SD	Organising pneumonia	✓	✓	✓
SD	Pneumonia	✓	✓	✓
SD	Pneumonia bacterial	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Surgery	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Thirst	✓	✓	✓

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