ZJL-32186-25123

3 vaccinations 10 coded responses 19 check-ins 9 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 852 / AZ
Registered: 2021-03-07

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-02-06
Dose 1 — Moderna
2021-03-06
Dose 2 — Moderna
2021-03-07
Registered in v-safe
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Abnormal dreams, Dry eye, Dry mouth — Feeling: Fair · Site: Pain, Redness · Fever · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: very dry eyes and mouth; vivid dream

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

Free text: Had chronic angina, took angio spray, boring sharp pain on left side of head for few minutes,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Fever · Fatigue or tiredness, Nausea · Be unable to work

Adult check-in
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Facial pain — Feeling: Good · Fatigue or tiredness

Free text: Temple sharp pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Headache — Feeling: Good · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness

Free text: Sharp, stabbing pain left top of head

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-27
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-05
Survey response — 3 months, dose 2
MedDRA: Ear pain, Fatigue, Headache, Heart rate increased, Hypotension, Oropharyngeal pain, Vision blurred — 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: Blurry vision/low BP/fast heart rate/fatigue/sharp pain in left temple, ears, throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-05
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)
2021-09-04
Survey response — 6 months, dose 2
MedDRA: Feeling hot, Perineal disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Warm discomfort perineal area

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-04
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-07
Call 2 — Left Voicemail
2022-02-04
Dose 3 — Pfizer-BioNTech
2022-03-06
Survey response — 12 months, dose 2
MedDRA: Angina pectoris, Arthralgia, Dyspnoea, Headache, Neck pain, Skin infection, Thyroiditis, Unevaluable event — 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 · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Symptoms: Stable angina; iskin infection; thyroiditis; Shortness of breath; arthritic pain; severe neck and head pain · Healthcare visit (other): Lab tests; scans

MedDRA releases: 2024-11 · check-in free text available
2022-03-06
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

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2022-03-10
Call 1 — Left Voicemail
2022-03-11
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-03-18
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-05-08
Survey response — 3 months, dose 3
MedDRA: Abdominal pain upper, Angina pectoris, Chest pain, Defaecation urgency, Joint swelling, Peripheral swelling, Rash, Visual impairment — Feeling: Fair · 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: Chest pain, angina, leg ankle feet swelling, visual disturbances, skin rashes, pain in upper abdomen with agency to evacuate meal eaten

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Report sent to call center — 3 months, dose 3
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)
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-05-10
Call 2 — Left Voicemail
2022-05-10
Call 1 — Left Voicemail
2022-08-05
Survey response — 6 months, dose 3
MedDRA: Angina pectoris — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Heart (angina)

MedDRA releases: 2024-11 · check-in free text available
2022-08-05
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)
2022-08-08
Call 1 — Left Voicemail
2023-02-04
Survey response — 12 months, dose 3
MedDRA: Back pain, Chest pain, Fatigue, Hypoaesthesia, Muscular weakness, Nausea, Neck pain, Oropharyngeal pain, Pruritus, Sensation of foreign body, Vision blurred — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-02-04
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-02-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-06
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	2021-02-06	Moderna
2	2021-03-06	Moderna
3	2022-02-04	Pfizer-BioNTech	No

Call center

Reported	Outcome	VAERS-related outcome
2021-06-05	Successful 2023-02-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-09-04	Successful 2023-02-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-03-06	Successful 2023-02-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-08	Successful 2023-02-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-05	Successful 2023-02-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-04	Successful 2023-02-06	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-08

Systemic reaction (other): very dry eyes and mouth; vivid dream

2021-03-09

Systemic reaction (other): Had chronic angina, took angio spray, boring sharp pain on left side of head for few minutes,

2021-03-11

Systemic reaction (other): Temple sharp pain

2021-03-12

Systemic reaction (other): Sharp, stabbing pain left top of head

Release 8 — 3 months, dose 2

2021-06-05

Symptoms: Blurry vision/low BP/fast heart rate/fatigue/sharp pain in left temple, ears, throat

Release 9 — 6 months, dose 2

2021-09-04

Symptoms: Warm discomfort perineal area

Release 11 — 12 months, dose 2

2022-03-06

Symptoms: Stable angina; iskin infection; thyroiditis; Shortness of breath; arthritic pain; severe neck and head pain

Healthcare visit (other): Lab tests; scans

Release 11 — 3 months, dose 3

2022-05-08

Symptoms: Chest pain, angina, leg ankle feet swelling, visual disturbances, skin rashes, pain in upper abdomen with agency to evacuate meal eaten

Release 12 — 6 months, dose 3

2022-08-05

Symptoms: Heart (angina)

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	Unevaluable event	·	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Angina pectoris	·	·	✓
SD	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Chest pain	·	·	✓
SD	Defaecation urgency	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Ear pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling hot	✓	·	✓
SD	Headache	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Hypoaesthesia	·	·	✓
SD	Hypotension	✓	✓	✓
SD	Joint swelling	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Nausea	·	·	✓
SD	Neck pain	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Perineal disorder	✓	·	✓
SD	Peripheral swelling	·	·	✓
SD	Pruritus	·	·	✓
SD	Rash	·	·	✓
SD	Sensation of foreign body	·	·	✓
SD	Skin infection	·	·	✓
SD	Thyroiditis	·	·	✓
SD	Vision blurred	✓	✓	✓
SD	Visual impairment	·	·	✓
SRO	Abnormal dreams	✓	✓	✓
SRO	Dry eye	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Facial pain	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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