ZJC-67969-82126

5 vaccinations 16 coded responses 64 check-ins 15 free-text entries 8 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 970 / OR
Registered: 2021-01-22

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

2021-01-22
Registered in v-safe
2021-01-22
Dose 1 — Moderna
2021-01-22
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling cold — Feeling: Fair · Site: Pain, Redness · Fever · Joint pains, Muscle or body aches, Abdominal pain · Be unable to do your normal daily activities

Free text: I am cold, but not shivering chills. Weird feeling.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-01-29
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-12
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-24
Dose 2 — Moderna
2021-02-24
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-03
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Survey response — day 14, dose 2
MedDRA: Headache — Feeling: Good · Be unable to do your normal daily activities

Free text: Headaches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-26
Survey response — 3 months, dose 2
MedDRA: Nephrolithiasis, Oedema peripheral — Feeling: Good · 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: Very large kidney stone and unrelated severe lower leg edema.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-26
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)
2021-08-25
Survey response — 6 months, dose 2
MedDRA: Nephrolithiasis, Renal stone removal, Surgery — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Symptoms: Kidney stone. It was surgically removed 7/6/21 · Healthcare visit (other): Day surgery

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-25
Report sent to call center — 6 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

1 call case(s)
2021-08-31
Call 3 — Left Voicemail
2021-09-07
Call X — Left Voicemail
2021-10-31
Dose 3 — Moderna
Co-administered: Flu
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Feeling hot, Postmenopause — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I keep getting too hot. I am past menopause, but similar to hot flash that lasts maybe 10 minutes

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-07
Health check-in — day 7, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-14
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-21
Survey response — day 21, dose 3
MedDRA: Arthralgia, Fatigue, Myalgia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Very fatigued and intense joint and muscle pain for the last 6 days.

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-05
Survey response — day 35, dose 3
MedDRA: Dyspnoea exertional, Pain — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Increased body pain and shortness of breath with activity.

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-30
Survey response — 3 months, dose 3
MedDRA: Alopecia, Malaise, Nephrolithiasis, SARS-CoV-2 test negative, Skin disorder — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Last 10+ days had COVID symptoms, but negative test. Also, had a kidney stone. You called to follow-up, but I never could get through to call back. Also noticing skin changes and hair loss.

MedDRA releases: 2024-11 · check-in free text available
2022-01-30
Report sent to call center — 3 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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-01
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-22
Dose 4 — Moderna
2022-04-22
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-04-23
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2022-04-24
Survey response — days 1–6 daily, dose 4
MedDRA: Bradyphrenia, Brain fog, Dizziness, Somnolence — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Groggy, lightheaded, cloudy feeling. Slow processing.

MedDRA releases: 2024-11 · check-in free text available
2022-04-25
Survey response — days 1–6 daily, dose 4
MedDRA: Brain fog, Dizziness, Incoherent — Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Foggy headed, disjointed, almost drunk feeling since shot.

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · None

Adult check-in
2022-04-29
Health check-in — day 7, dose 4
Feeling: Fair · None

Adult check-in
2022-05-07
Survey response — day 14, dose 4
MedDRA: Eye infection — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Severe infection in both eyes.

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Report sent to call center — day 14, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-09
Call successful
Participant prefers to complete VAERS report online
2022-05-13
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-27
Survey response — day 35, dose 4
MedDRA: Urinary tract infection — Feeling: Fair · 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: UTI

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Report sent to call center — day 35, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-31
Call 1 — Left Voicemail
2022-05-31
Call 2 — Left Voicemail
2022-06-05
Survey response — day 42, dose 4
MedDRA: Abdominal pain upper, Nausea — 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: Stomach pain and nausea. Long term

MedDRA releases: 2024-11 · check-in free text available
2022-06-05
Report sent to call center — day 42, dose 4
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 · 1 call case(s)
2022-06-06
Call 2 — Left Voicemail
2022-07-22
Survey response — 3 months, dose 4
MedDRA: Gastrointestinal bacterial overgrowth, Gastrointestinal disorder — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Hospitalization

Free text: Extremely slow gut movement and SIBO.

MedDRA releases: 2024-11 · check-in free text available
2022-07-22
Report sent to call center — 3 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Hospitalization · 1 call case(s)
2022-07-25
Call 2 — Left Voicemail
2022-07-25
Call 2 — Left Voicemail
2022-07-25
Call 3 — Left Voicemail
2022-07-25
Call 3 — Left Voicemail
2022-07-25
Call 2 — Left Voicemail
2022-10-07
Dose 5 — Moderna
2022-10-08
Survey response — days 1–6 daily, dose 5
MedDRA: Cardiac failure, Weight increased — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Weight gain. I have heart failure and must weigh every day. I am up 3.4 pounds overnight.

MedDRA releases: 2024-11 · check-in free text available
2022-10-09
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-10-10
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Redness, Itching · Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2022-10-11
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Itching · Muscle or body aches · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-10-12
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2022-10-15
Health check-in — day 7, dose 5
Feeling: Good · Muscle or body aches

Adult check-in
2022-10-21
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-10-28
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-11-04
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-13
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-18
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-06
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-07
Survey response — 6 months, dose 5
MedDRA: Cardiac disorder, Infection, Lung disorder, Pain — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-04-07
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2023-04-10
Call 1 — Left Voicemail
2023-04-10
Call 1 — Left Voicemail
2023-04-10
Call 1 — Left Voicemail
2023-04-10
Call 1 — Left Voicemail
2023-04-10
Call 1 — Left Voicemail
2023-04-10
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-24	Moderna
3	2021-10-31	Moderna	Flu
4	2022-04-22	Moderna	No
5	2022-10-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-26	Successful 2022-02-01	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-08-25	Successful 2022-02-01	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-01-30	Successful 2022-02-01	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-07	Successful 2022-05-09	Participant prefers to complete VAERS report online
2022-05-27	Unsuccessful
2022-06-05	Unsuccessful
2022-07-22	Unsuccessful
2023-04-07	Unsuccessful

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-23

Systemic reaction (other): I am cold, but not shivering chills. Weird feeling.

Release 5 — day 14, dose 2

2021-03-10

Symptoms: Headaches

Release 8 — 3 months, dose 2

2021-05-26

Symptoms: Very large kidney stone and unrelated severe lower leg edema.

Release 9 — 6 months, dose 2

2021-08-25

Symptoms: Kidney stone. It was surgically removed 7/6/21

Healthcare visit (other): Day surgery

Release 10 — days 1–6 daily, dose 3

2021-11-01

Systemic reaction (other): I keep getting too hot. I am past menopause, but similar to hot flash that lasts maybe 10 minutes

Release 10 — day 21, dose 3

2021-11-21

Symptoms: Very fatigued and intense joint and muscle pain for the last 6 days.

Release 10 — day 35, dose 3

2021-12-05

Symptoms: Increased body pain and shortness of breath with activity.

Release 11 — 3 months, dose 3

2022-01-30

Symptoms: Last 10+ days had COVID symptoms, but negative test. Also, had a kidney stone. You called to follow-up, but I never could get through to call back. Also noticing skin changes and hair loss.

Release 11 — days 1–6 daily, dose 4

2022-04-24

Systemic reaction (other): Groggy, lightheaded, cloudy feeling. Slow processing.

2022-04-25

Systemic reaction (other): Foggy headed, disjointed, almost drunk feeling since shot.

Release 11 — day 14, dose 4

2022-05-07

Symptoms: Severe infection in both eyes.

Release 11 — day 35, dose 4

2022-05-27

Symptoms: UTI

Release 11 — day 42, dose 4

2022-06-05

Symptoms: Stomach pain and nausea. Long term

Release 12 — 3 months, dose 4

2022-07-22

Symptoms: Extremely slow gut movement and SIBO.

Release 12 — days 1–6 daily, dose 5

2022-10-08

Systemic reaction (other): Weight gain. I have heart failure and must weigh every day. I am up 3.4 pounds overnight.

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	Surgery	✓	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Alopecia	·	·	✓
SD	Arthralgia	·	·	✓
SD	Cardiac disorder	·	·	✓
SD	Dyspnoea exertional	·	·	✓
SD	Eye infection	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastrointestinal bacterial overgrowth	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	✓	✓	✓
SD	Infection	·	·	✓
SD	Lung disorder	·	·	✓
SD	Malaise	·	·	✓
SD	Myalgia	·	·	✓
SD	Nausea	·	·	✓
SD	Nephrolithiasis	✓	✓	✓
SD	Oedema peripheral	✓	✓	✓
SD	Pain	·	·	✓
SD	Renal stone removal	✓	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Skin disorder	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Bradyphrenia	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Cardiac failure	·	·	✓
SRO	Dizziness	·	·	✓
SRO	Feeling cold	✓	✓	✓
SRO	Feeling hot	·	·	✓
SRO	Incoherent	·	·	✓
SRO	Postmenopause	·	·	✓
SRO	Somnolence	·	·	✓
SRO	Weight increased	·	·	✓

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