ZJS-12392-82257

5 vaccinations 23 coded responses 59 check-ins 23 free-text entries 3 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 778 / TX
Registered: 2021-02-23

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Registered dependents

6PN-27867-15698 Child or adolescent in my care · Male · 2022-06-24

Timeline

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

2021-02-23
Registered in v-safe
2021-02-23
Dose 1 — Moderna
2021-02-23
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-03-02
Health check-in — day 7, dose 1
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-16
Survey response — day 21, dose 1
MedDRA: Injection site erythema — Feeling: Fair

Free text: Increased arm redness at injection site that appeared weeks after the fact.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-03-24
Dose 2 — Moderna
2021-03-24
Survey response — day 0, dose 2
MedDRA: Ear discomfort — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Ears feel clogged as if under water

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: Ear discomfort, Paraesthesia — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Pins and needles every where- particularly hands; clogged ears

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: Poor · Site: Pain, Redness, Swelling · 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
2021-03-27
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Free text: asthma flare up

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: Asthma — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: asthma triggered/flared

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Redness, Swelling, Itching · Nausea · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Aggrivated asthma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Fatigue or tiredness

Free text: Aggrivated asthma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — day 7, dose 2
MedDRA: Asthma, Pre-existing disease — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Fatigue or tiredness

Free text: Aggrivated asthma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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: Fair

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

Adult check-in
2021-04-30
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-05
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-06-23
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-22
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-12-10
Dose 3 — Moderna
2021-12-11
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, 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
2021-12-12
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma, Cough, Lymph node pain, Lymphadenopathy, Pre-existing disease, Wheezing — Feeling: Poor · Site: Pain, Swelling · Chills, 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: Painfully swollen armpit on injection side only (lymph nodes) & triggered asthma (wheezing, coughing)

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma, Axillary pain, Cough, Pre-existing disease, Wheezing — Feeling: Poor · Site: Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Severe armpit pain (lymph node?), aggrivated asthma (cough, wheezing)

MedDRA releases: 2024-11 · check-in free text available
2021-12-14
Survey response — days 1–6 daily, dose 3
MedDRA: Asthma, Axillary pain, Pre-existing disease — Feeling: Poor · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Painful armpit on injection side, aggravated asthma

MedDRA releases: 2024-11 · check-in free text available
2021-12-15
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Cough, Oedema peripheral — Feeling: Poor · Headache, Fatigue or tiredness

Free text: Painful swollen ipsilatereal armpit, cough

MedDRA releases: 2024-11 · check-in free text available
2021-12-16
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Condition aggravated, Cough, Pre-existing disease — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Armpit pain, cough/aggravated asthma

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — day 7, dose 3
MedDRA: Asthma, Cough, Pre-existing disease, Wheezing — Feeling: Poor · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Aggrivated asthma (cough/wheezing)

MedDRA releases: 2024-11 · check-in free text available
2021-12-24
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-31
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-01-07
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2022-01-13
Call 1 — Left Voicemail
2022-01-14
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-01-21
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-03-13
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-24
Dose 4 — Moderna
2022-05-25
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, 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
2022-05-27
Survey response — days 1–6 daily, dose 4
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Painfully enlarged lymph node in armpit on the sode of injection

MedDRA releases: 2024-11 · check-in free text available
2022-05-28
Survey response — days 1–6 daily, dose 4
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swollen lymph nodes

MedDRA releases: 2024-11 · check-in free text available
2022-05-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-30
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-31
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-06-07
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-14
Survey response — day 21, dose 4
MedDRA: Fatigue, Headache, Oropharyngeal pain — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headache, fatigue, sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-06-21
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-06-30
Survey response — day 35, dose 4
MedDRA: Cough — Feeling: Fair

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2022-07-05
Survey response — day 42, dose 4
MedDRA: Cough, Dry eye, Fatigue — Feeling: Fair

Free text: Dry eye, cough, fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-09-30
Dose 5 — Moderna
2022-09-30
Survey response — day 0, dose 5
MedDRA: Cardiac flutter, Heart rate increased — Feeling: Fair · Site: Pain, Swelling · Chills, Muscle or body aches, Fatigue or tiredness

Free text: Faster heart rate and fluttering feeling

MedDRA releases: 2024-11 · check-in free text available
2022-10-01
Survey response — days 1–6 daily, dose 5
MedDRA: Heart rate increased — Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Elevated heart rate

MedDRA releases: 2024-11 · check-in free text available
2022-10-02
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-04
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-06
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-07
Health check-in — day 7, dose 5
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

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

Adult check-in
2022-10-23
Survey response — day 21, dose 5
MedDRA: Nasopharyngitis — Feeling: Poor · Be unable to do your normal daily activities

Free text: Bad cold

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Survey response — day 28, dose 5
MedDRA: Respiratory syncytial virus infection — 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 · Outpatient clinic or urgent care clinic visit

Free text: Rsv

MedDRA releases: 2024-11 · check-in free text available
2022-10-28
Report sent to call center — day 28, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-31
Call 1 — Left Voicemail
2022-10-31
Call 2 — Left Voicemail
2022-10-31
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-23	Moderna
2	2021-03-24	Moderna
3	2021-12-10	Moderna	No
4	2022-05-24	Moderna	No
5	2022-09-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-28	Unsuccessful
2021-03-29	Unsuccessful
2022-10-28	Unsuccessful

Free text

Release 5 — day 21, dose 1

2021-03-16

Symptoms: Increased arm redness at injection site that appeared weeks after the fact.

Release 6 — day 0, dose 2

2021-03-24

Systemic reaction (other): Ears feel clogged as if under water

Release 6 — days 1–6 daily, dose 2

2021-03-25

Systemic reaction (other): Pins and needles every where- particularly hands; clogged ears

2021-03-27

Systemic reaction (other): asthma flare up

2021-03-28

Systemic reaction (other): asthma triggered/flared

2021-03-29

Systemic reaction (other): Aggrivated asthma

2021-03-30

Systemic reaction (other): Aggrivated asthma

Release 6 — day 7, dose 2

2021-03-31

Systemic reaction (other): Aggrivated asthma

Release 10 — days 1–6 daily, dose 3

2021-12-12

Systemic reaction (other): Painfully swollen armpit on injection side only (lymph nodes) & triggered asthma (wheezing, coughing)

2021-12-13

Systemic reaction (other): Severe armpit pain (lymph node?), aggrivated asthma (cough, wheezing)

2021-12-14

Systemic reaction (other): Painful armpit on injection side, aggravated asthma

2021-12-15

Systemic reaction (other): Painful swollen ipsilatereal armpit, cough

2021-12-16

Systemic reaction (other): Armpit pain, cough/aggravated asthma

Release 10 — day 7, dose 3

2021-12-17

Systemic reaction (other): Aggrivated asthma (cough/wheezing)

Release 11 — days 1–6 daily, dose 4

2022-05-27

Systemic reaction (other): Painfully enlarged lymph node in armpit on the sode of injection

2022-05-28

Systemic reaction (other): Swollen lymph nodes

Release 12 — day 21, dose 4

2022-06-14

Symptoms: Headache, fatigue, sore throat

Release 12 — day 35, dose 4

2022-06-30

Symptoms: Cough

Release 12 — day 42, dose 4

2022-07-05

Symptoms: Dry eye, cough, fatigue

Release 12 — day 0, dose 5

2022-09-30

Systemic reaction (other): Faster heart rate and fluttering feeling

Release 12 — days 1–6 daily, dose 5

2022-10-01

Systemic reaction (other): Elevated heart rate

Release 12 — day 21, dose 5

2022-10-23

Symptoms: Bad cold

Release 12 — day 28, dose 5

2022-10-28

Symptoms: Rsv

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
SD	Cough	·	·	✓
SD	Dry eye	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Respiratory syncytial virus infection	·	·	✓
SRO	Asthma	✓	✓	✓
SRO	Axillary pain	·	·	✓
SRO	Cardiac flutter	·	·	✓
SRO	Condition aggravated	·	·	✓
SRO	Cough	·	·	✓
SRO	Ear discomfort	✓	✓	✓
SRO	Heart rate increased	·	·	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Oedema peripheral	·	·	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Wheezing	·	·	✓

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