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ZHA-12933-01887

2 vaccinations 5 coded responses 25 check-ins 5 free-text entries 1 call case
Sex
Female
Age at first dose
46-50
ZIP prefix
545 / WI
Registered
2021-03-09
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino
Registered dependents
85H-30504-65962 Child or adolescent in my care · Female · 2021-08-10

Timeline

  1. 2021-03-09
    Registered in v-safe
  2. 2021-03-09
    Dose 1 — Moderna
  3. 2021-03-09
    Health check-in — day 0, dose 1
    Feeling: Good · None
    Adult check-in
  4. 2021-03-10
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Headache, Diarrhea
    Adult check-in
  5. 2021-03-11
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · Abdominal pain
    Adult check-in
  6. 2021-03-12
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Muscle or body aches
    Adult check-in
  7. 2021-03-13
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  8. 2021-03-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness, Abdominal pain
    Adult check-in
  9. 2021-03-15
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · None
    Adult check-in
  10. 2021-03-16
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-03-23
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-03-30
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-04-06
    Dose 2 — Moderna
  14. 2021-04-06
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-04-07
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain, Swelling · Chills, Joint pains, Muscle or body aches, Nausea
    Adult check-in
  16. 2021-04-09
    Survey response — days 1–6 daily, dose 2
    MedDRA: Epistaxis — Feeling: Fair · Site: Redness, Itching · Nausea, Abdominal pain
    Free text: Bloody nose
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-04-10
    Survey response — days 1–6 daily, dose 2
    MedDRA: Condition aggravated, Pain, Pre-existing disease, Swelling — Feeling: Fair · Site: Itching · Fever · Chills, Joint pains · Be unable to do your normal daily activities
    Free text: Swelling and pain in an old injury, a tendon sprain that occurred following an antibiotic known to cause that side effect.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-04-11
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Muscle or body aches, Fatigue or tiredness
    Adult check-in
  19. 2021-04-12
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Muscle or body aches, Fatigue or tiredness
    Adult check-in
  20. 2021-04-13
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-04-20
    Survey response — day 14, dose 2
    MedDRA: Migraine, Myalgia — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Migraine, muscle ache
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  22. 2021-04-27
    Survey response — day 21, dose 2
    MedDRA: Eye pain, Fatigue, Headache — Feeling: Fair
    Free text: Eye pain. Like an ache or fatigue and dryness in one eye, followed by a bit of a headache.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  23. 2021-05-04
    Health check-in — day 28, dose 2
    Feeling: Poor
    Adult check-in
  24. 2021-05-11
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-05-18
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-07-06
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-10-05
    Health check-in — 6 months, dose 2
    Feeling: Fair
    Adult check-in
  28. 2022-04-06
    Survey response — 12 months, dose 2
    MedDRA: Malaise, Medical counselling, Pneumonia — Feeling: Poor · 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
    Free text: Have an infection in my lung that I'm being referred to Pulmonology to review. Have been sick with infections for 4 months. Antibiotics and prednisone have not improved my conditions.
    MedDRA releases: 2024-11 · check-in free text available
  29. 2022-04-06
    Report sent to call center — 12 months, dose 2
    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 · 1 call case(s)
  30. 2022-04-11

Vaccinations

DoseDateManufacturerCo-administered
12021-03-09Moderna
22021-04-06Moderna

Call center

ReportedOutcomeVAERS-related outcome
2022-04-06 Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-09

Systemic reaction (other): Bloody nose

2021-04-10

Systemic reaction (other): Swelling and pain in an old injury, a tendon sprain that occurred following an antibiotic known to cause that side effect.

Release 7 — day 14, dose 2

2021-04-20

Symptoms: Migraine, muscle ache

Release 8 — day 21, dose 2

2021-04-27

Symptoms: Eye pain. Like an ache or fatigue and dryness in one eye, followed by a bit of a headache.

Release 11 — 12 months, dose 2

2022-04-06

Symptoms: Have an infection in my lung that I'm being referred to Pulmonology to review. Have been sick with infections for 4 months. Antibiotics and prednisone have not improved my conditions.

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

FieldPreferred term2021-092023-042024-11
SDEye pain ✓ ✓ ✓
SDFatigue ✓ ✓ ✓
SDHeadache ✓ ✓ ✓
SDMalaise · · ✓
SDMedical counselling · · ✓
SDMigraine ✓ ✓ ✓
SDMyalgia ✓ ✓ ✓
SDPneumonia · · ✓
SROCondition aggravated ✓ ✓ ✓
SROEpistaxis ✓ ✓ ✓
SROPain ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓
SROSwelling ✓ ✓ ✓

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