ZKL-90511-57914

2 vaccinations 7 coded responses 21 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 243 / VA
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
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-30
Survey response — day 14, dose 1
MedDRA: Eye swelling, Fatigue, Headache, Pain, Pain in jaw, Swelling face — Feeling: Poor · Be unable to work, 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: Headaches, jaw pain, right side of face swollen especially eye, achy and tired. I don't think out was vaccines related i think it is whatever is wrong with me that my dr. believes to be the beginning of am autoimmune disorder but can't pinpoint .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Report sent to call center — day 14, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-05
Survey response — day 21, dose 1
MedDRA: Headache, Pre-existing disease, Urticaria — 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: A few hives...may not bre related to shotSevere headache...may not be related to shot,,,i have migraines

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Report sent to call center — day 21, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-11
Dose 2 — Moderna
2021-02-11
Survey response — day 0, dose 2
MedDRA: Rash, Urticaria — Feeling: Good · Site: Pain, Itching · Rash, not including the immediate area around the injection site

Free text: The rash is more like hives

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — days 1–6 daily, dose 2
MedDRA: Hypoaesthesia, Pre-existing disease, Self-medication, Urticaria, Wheezing — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Injection was on the left side. Numbness in arms ,especially in injection arm... from shoulder to elbow on both arms and to the elbow to the pinkie side of the wrist on the injection side. Also, the rash (more like hives) has flattened out more and have disappeared except on my left breast. I used zyrtec and benedryl. My costochondritis is acting up and my left lung felt wheezy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Chest discomfort, Feeling hot, Headache — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: I feel like I'm on fire inside especially around my joints, but I am not running a fever. Really bad headache and my ribs feel tight.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache

Adult check-in
2021-02-18
Survey response — day 7, dose 2
MedDRA: Discomfort, Dizziness — Feeling: Poor · Fever · Headache, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Dizzy and faint, right side at mid to bottom rib feels like its very heavy and tight.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-04
Survey response — day 21, dose 2
MedDRA: Diarrhoea, Headache, Pain, Respiratory tract congestion, Vomiting — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Severe headache, body aches, vomitting, diarrhea, congestion

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

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

Adult check-in
2021-03-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-11
Call successful
Does not wish to fill out VAERS report
2022-02-13
Health check-in — 12 months, dose 2
Feeling: Poor

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
2021-01-30	Successful	Does not wish to fill out VAERS report
2021-02-05	Successful 2021-06-11	Does not wish to fill out VAERS report

Free text

Release 3 — day 14, dose 1

2021-01-30

Symptoms: Headaches, jaw pain, right side of face swollen especially eye, achy and tired. I don't think out was vaccines related i think it is whatever is wrong with me that my dr. believes to be the beginning of am autoimmune disorder but can't pinpoint .

Release 3 — day 21, dose 1

2021-02-05

Symptoms: A few hives...may not bre related to shotSevere headache...may not be related to shot,,,i have migraines

Release 4 — day 0, dose 2

2021-02-11

Systemic reaction (other): The rash is more like hives

Release 4 — days 1–6 daily, dose 2

2021-02-12

Systemic reaction (other): Injection was on the left side. Numbness in arms ,especially in injection arm... from shoulder to elbow on both arms and to the elbow to the pinkie side of the wrist on the injection side. Also, the rash (more like hives) has flattened out more and have disappeared except on my left breast. I used zyrtec and benedryl. My costochondritis is acting up and my left lung felt wheezy.

2021-02-14

Systemic reaction (other): I feel like I'm on fire inside especially around my joints, but I am not running a fever. Really bad headache and my ribs feel tight.

Release 4 — day 7, dose 2

2021-02-18

Systemic reaction (other): Dizzy and faint, right side at mid to bottom rib feels like its very heavy and tight.

Release 5 — day 21, dose 2

2021-03-04

Symptoms: Severe headache, body aches, vomitting, diarrhea, congestion

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	Diarrhoea	✓	✓	✓
SD	Eye swelling	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in jaw	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Swelling face	✓	✓	✓
SD	Urticaria	✓	✓	✓
SD	Vomiting	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Discomfort	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Urticaria	✓	✓	✓
SRO	Wheezing	✓	✓	✓

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