ZJY-58098-27445

2 vaccinations 8 coded responses 26 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 065 / CT
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Survey response — day 0, dose 1
MedDRA: Dry mouth, Tongue dry — Feeling: Good

Free text: Tongue/mouth feels dry.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Aphthous ulcer — Feeling: Fair · Fatigue or tiredness

Free text: Canker sores in mouth.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Aphthous ulcer, Headache, Pyrexia — Feeling: Fair · Fever · Headache, Fatigue or tiredness

Free text: Still canker soars in mouth. Slight headache. Felt feverish no fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Aphthous ulcer, Dry mouth, Fatigue, Medical counselling — Feeling: Fair · Fatigue or tiredness · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Still some canker sores and dry mouth. Better than last few days. · Healthcare visit (other): PCP Is NOT concerned with mouth/canker sores or fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-20
Survey response — days 1–6 daily, dose 1
MedDRA: Aphthous ulcer — Feeling: Good · Fatigue or tiredness

Free text: Most canker sores gone.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — day 7, dose 1
MedDRA: Aphthous ulcer — Feeling: Good · Headache

Free text: Canker sores are gone finally

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — day 14, dose 1
MedDRA: Aphthous ulcer, Respiratory tract congestion — Feeling: Fair

Free text: Chest congestion and still some canker sores in mouth. 2 weeks out unsure if virus/cold or vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Survey response — day 0, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain

Free text: Literally got 2 minutes ago.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-18
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-24
Call 1 — Left Voicemail
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-14
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-02-11
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-19	Unsuccessful

Free text

Release 2 — day 0, dose 1

2021-01-14

Systemic reaction (other): Tongue/mouth feels dry.

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Canker sores in mouth.

2021-01-18

Systemic reaction (other): Still canker soars in mouth. Slight headache. Felt feverish no fever

2021-01-19

Systemic reaction (other): Still some canker sores and dry mouth. Better than last few days.

Healthcare visit (other): PCP Is NOT concerned with mouth/canker sores or fatigue.

2021-01-20

Systemic reaction (other): Most canker sores gone.

Release 2 — day 7, dose 1

2021-01-21

Systemic reaction (other): Canker sores are gone finally

Release 3 — day 14, dose 1

2021-01-28

Symptoms: Chest congestion and still some canker sores in mouth. 2 weeks out unsure if virus/cold or vaccine.

Release 4 — day 0, dose 2

2021-02-11

Systemic reaction (other): Literally got 2 minutes ago.

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	Aphthous ulcer	✓	✓	✓
HCVO	Fatigue	✓	✓	✓
HCVO	Medical counselling	✓	✓	✓
SD	Aphthous ulcer	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SRO	Aphthous ulcer	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Tongue dry	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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