ZHX-32972-56949

3 vaccinations 7 coded responses 23 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 484 / MI
Registered: 2021-03-12

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

2021-03-01
Dose 1 — Moderna
2021-03-12
Registered in v-safe
2021-03-12
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-15
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-22
Survey response — day 21, dose 1
MedDRA: Rash — Feeling: Fair

Free text: I have a rash on my arms, particularly in the inner bend of my elbows

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Dose 2 — Moderna
2021-03-29
Survey response — day 0, dose 2
MedDRA: Pain in jaw — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Pain in my upper left jaw

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Joint pains

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-05
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains

Adult check-in
2021-04-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-26
Survey response — day 28, dose 2
MedDRA: Chest pain, Ear pain, Hypoaesthesia, Pain in extremity, Pain in jaw — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Chest pain. Arm numbness. Sore jaw and ear ache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-03
Survey response — day 35, dose 2
MedDRA: Chest pain, Gastric disorder — Feeling: Poor · Be unable to do your normal daily activities

Free text: Chest pain and gastric trouble

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-28
Survey response — 3 months, dose 2
MedDRA: Fungal infection — Feeling: Good

Free text: Yeast infextion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-21
Dose 3 — Moderna
2021-09-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-02
Survey response — day 42, dose 3
MedDRA: Vascular stent stenosis — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: One of my heart stents suddenly and unexplainably has a severe stenosis. Probably unrelated, but rather shocking.

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Report sent to call center — day 42, dose 3
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-03
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2021-12-21
Survey response — 3 months, dose 3
MedDRA: Office visit, Procedural complication, Superficial vein thrombosis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I developed minor surface blood clots in my arm after having an iv inserted during a procedure. · Healthcare visit (other): Just pcp

MedDRA releases: 2024-11 · check-in free text available
2021-12-21
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-23
Call successful
Does not wish to fill out VAERS report
2022-03-22
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-21
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-01	Moderna
2	2021-03-29	Moderna
3	2021-09-21	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-26	Successful	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-02	Successful 2021-11-03	Reported to VAERS voluntarily prior to GDIT contact
2021-12-21	Successful 2021-12-23	Does not wish to fill out VAERS report

Free text

Release 6 — day 21, dose 1

2021-03-22

Symptoms: I have a rash on my arms, particularly in the inner bend of my elbows

Release 6 — day 0, dose 2

2021-03-29

Systemic reaction (other): Pain in my upper left jaw

Release 8 — day 28, dose 2

2021-04-26

Symptoms: Chest pain. Arm numbness. Sore jaw and ear ache.

Release 8 — day 35, dose 2

2021-05-03

Symptoms: Chest pain and gastric trouble

Release 9 — 3 months, dose 2

2021-06-28

Symptoms: Yeast infextion

Release 10 — day 42, dose 3

2021-11-02

Symptoms: One of my heart stents suddenly and unexplainably has a severe stenosis. Probably unrelated, but rather shocking.

Release 10 — 3 months, dose 3

2021-12-21

Symptoms: I developed minor surface blood clots in my arm after having an iv inserted during a procedure.

Healthcare visit (other): Just pcp

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	Chest pain	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Fungal infection	✓	✓	✓
SD	Gastric disorder	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pain in jaw	✓	✓	✓
SD	Procedural complication	·	·	✓
SD	Rash	✓	✓	✓
SD	Superficial vein thrombosis	·	·	✓
SD	Vascular stent stenosis	·	·	✓
SRO	Pain in jaw	✓	✓	✓

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