ZKJ-95687-58458

3 vaccinations 10 coded responses 37 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 786 / TX
Registered: 2021-01-26

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

2021-01-26
Registered in v-safe
2021-01-26
Dose 1 — Moderna
2021-01-26
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-02-02
Survey response — day 7, dose 1
MedDRA: Erythema, Urticaria — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache

Free text: Hives/red area moved and got larger

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-26
Dose 2 — Moderna
2021-02-26
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Fatigue or tiredness

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

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

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

Adult check-in
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Rhinorrhoea — Feeling: Fair · Fever · Chills, Headache, Fatigue or tiredness

Free text: Runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-03-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-19
Survey response — day 21, dose 2
MedDRA: Pre-existing disease — Feeling: Fair

Free text: Asthma, probably spring allergies

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-30
Survey response — 3 months, dose 2
MedDRA: Gastroenteritis viral — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Stomach bug symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-27
Survey response — 6 months, dose 2
MedDRA: Nasopharyngitis — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I had cold symptoms for 3 days at the end of July, didnt get tested.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-01
Dose 3 — Moderna
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Dyspnoea — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Shortness of breath 8 hours after, pain under arm

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Oedema peripheral — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Pain is worse in armpit and some swelling

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain — Feeling: Fair · Fatigue or tiredness

Free text: Pain under arm

MedDRA releases: 2024-11 · check-in free text available
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 · Fatigue or tiredness

Adult check-in
2021-11-08
Survey response — day 7, dose 3
MedDRA: Mouth ulceration — Feeling: Good

Free text: I had mouth ulcers the day after the shot that are finally gone. Not sure if it's related to shot or not

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-13
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-31
Survey response — 3 months, dose 3
MedDRA: Dyspnoea, Headache, Pyrexia — 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

Free text: Fever, headache, shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2022-01-31
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 · 1 call case(s)
2022-03-30
Call 1 — Left Voicemail
2022-11-03
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-02-26	Moderna
3	2021-11-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-01-31	Unsuccessful

Free text

Release 3 — day 7, dose 1

2021-02-02

Systemic reaction (other): Hives/red area moved and got larger

Release 5 — days 1–6 daily, dose 2

2021-03-03

Systemic reaction (other): Runny nose

Release 5 — day 21, dose 2

2021-03-19

Symptoms: Asthma, probably spring allergies

Release 8 — 3 months, dose 2

2021-05-30

Symptoms: Stomach bug symptoms

Release 9 — 6 months, dose 2

2021-08-27

Symptoms: I had cold symptoms for 3 days at the end of July, didnt get tested.

Release 10 — days 1–6 daily, dose 3

2021-11-02

Systemic reaction (other): Shortness of breath 8 hours after, pain under arm

2021-11-03

Systemic reaction (other): Pain is worse in armpit and some swelling

2021-11-04

Systemic reaction (other): Pain under arm

Release 10 — day 7, dose 3

2021-11-08

Systemic reaction (other): I had mouth ulcers the day after the shot that are finally gone. Not sure if it's related to shot or not

Release 11 — 3 months, dose 3

2022-01-31

Symptoms: Fever, headache, shortness of breath

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	Dyspnoea	·	·	✓
SD	Gastroenteritis viral	✓	✓	✓
SD	Headache	·	·	✓
SD	Nasopharyngitis	✓	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Erythema	✓	✓	✓
SRO	Mouth ulceration	·	·	✓
SRO	Oedema peripheral	·	·	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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