ZHP-14947-73100

2 vaccinations 11 coded responses 22 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 620 / IL
Registered: 2021-02-27

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

2021-02-24
Dose 1 — Moderna
2021-02-27
Registered in v-safe
2021-02-27
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: No appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-03
Survey response — day 7, dose 1
MedDRA: Dry mouth, Feeling abnormal — Feeling: Good

Free text: Brain Fog, extreme dry mouth: have had both since Dec 29, 2020 when I had COVID. In last few days have I have noticed excess hair loss,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-17
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-24
Dose 2 — Moderna
2021-03-24
Survey response — day 0, dose 2
MedDRA: Alopecia, Decreased appetite, Dry mouth — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Hair continues to come out by the handful. Dry mouth, no appetite.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Survey response — days 1–6 daily, dose 2
MedDRA: Alopecia — Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Hair still falling out

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-27
Survey response — days 1–6 daily, dose 2
MedDRA: Alopecia — Feeling: Good · Abdominal pain

Free text: Hair still falling out

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Survey response — days 1–6 daily, dose 2
MedDRA: Therapeutic response unexpected — Feeling: Good · Headache

Free text: Less hair loss! Yeah !!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Good · Headache, Abdominal pain

Free text: Asthma is acting up today-very windy so allergies are a problem.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain upper, Alopecia, Asthma, Cough, Pre-existing disease — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Free text: Hair falling out is back. Cough. Think I am having allergies today, except for the stomach ache. Dont usually have that with asthma/allergies.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-14
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-21
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-28
Survey response — day 35, dose 2
MedDRA: Cough, Decreased appetite, Diarrhoea, Fatigue, Headache, Nausea, Pyrexia, Vomiting — Feeling: Fair · Be unable to do your normal daily activities

Free text: Had vomiting and diarrhea with extreme fatigue for 2 days, 3 days ago. No fever. No appetite. Some coughing and headache. Same symptoms as when had covid.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-23
Survey response — 3 months, dose 2
MedDRA: Brain fog, Dyspnoea, Fatigue, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: More asthma than in the past. Hard to breathe. Have to use rescue inhaler several times a week as compared to once a month. Still having brain fog and fatigue. · Healthcare visit (other): Saw pulmonologist earlier than normally scheduled visit. Took chest exam, normal. Did COVID-19 test, normal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-23
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-30
Call 1 — Left Voicemail
2021-09-22
Survey response — 6 months, dose 2
MedDRA: Chemotherapy, Pancreatic carcinoma — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Diagnosed with pancreatic cancer. Getting chemotherapy.

MedDRA releases: 2024-11 · check-in free text available
2021-09-22
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-23
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-24	Moderna
2	2021-03-24	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-23	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-22	Successful 2021-09-23	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-27

Systemic reaction (other): No appetite

Release 5 — day 7, dose 1

2021-03-03

Systemic reaction (other): Brain Fog, extreme dry mouth: have had both since Dec 29, 2020 when I had COVID. In last few days have I have noticed excess hair loss,

Release 6 — day 0, dose 2

2021-03-24

Systemic reaction (other): Hair continues to come out by the handful. Dry mouth, no appetite.

Release 6 — days 1–6 daily, dose 2

2021-03-25

Systemic reaction (other): Hair still falling out

2021-03-27

Systemic reaction (other): Hair still falling out

2021-03-28

Systemic reaction (other): Less hair loss! Yeah !!

2021-03-29

Systemic reaction (other): Asthma is acting up today-very windy so allergies are a problem.

2021-03-30

Systemic reaction (other): Hair falling out is back. Cough. Think I am having allergies today, except for the stomach ache. Dont usually have that with asthma/allergies.

Release 8 — day 35, dose 2

2021-04-28

Symptoms: Had vomiting and diarrhea with extreme fatigue for 2 days, 3 days ago. No fever. No appetite. Some coughing and headache. Same symptoms as when had covid.

Release 9 — 3 months, dose 2

2021-06-23

Symptoms: More asthma than in the past. Hard to breathe. Have to use rescue inhaler several times a week as compared to once a month. Still having brain fog and fatigue.

Healthcare visit (other): Saw pulmonologist earlier than normally scheduled visit. Took chest exam, normal. Did COVID-19 test, normal.

Release 9 — 6 months, dose 2

2021-09-22

Symptoms: Diagnosed with pancreatic cancer. Getting chemotherapy.

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	Office visit	✓	✓	✓
SD	Brain fog	✓	✓	✓
SD	Chemotherapy	·	·	✓
SD	Cough	·	·	✓
SD	Decreased appetite	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Nausea	✓	✓	○
SD	Pancreatic carcinoma	·	·	✓
SD	Pyrexia	✓	✓	○
SD	Vomiting	✓	✓	✓
SRO	Abdominal pain upper	✓	✓	✓
SRO	Alopecia	✓	✓	✓
SRO	Asthma	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Therapeutic response unexpected	✓	✓	✓

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