ZKM-76328-41943

3 vaccinations 6 coded responses 31 check-ins 6 free-text entries 4 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 152 / PA
Registered: 2021-03-10

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

2021-03-10
Registered in v-safe
2021-03-10
Dose 1 — Moderna
2021-03-10
Survey response — day 0, dose 1
MedDRA: Chest pain, Disorientation, Immediate post-injection reaction — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Slight sense of disorientation/chest pain first 20 minutes after vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Diarrhea, Abdominal pain

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-17
Health check-in — day 7, dose 1
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-07
Dose 2 — Moderna
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Itching · 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
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-14
Health check-in — day 7, dose 2
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-21
Survey response — day 14, dose 2
MedDRA: Ear pain, Memory impairment — Feeling: Fair

Free text: This occurred during the first week but I forgot to include. Occasional and fleeting but sharp pains in both ears, occurring one ear at a time.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-05
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-05-19
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-07
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-10-06
Survey response — 6 months, dose 2
MedDRA: Kidney infection, Urinary tract 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Kidney infection/uti

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Report sent to call center — 6 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 · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2021-10-07
Call 1 — Left Voicemail
2021-11-04
Dose 3 — Moderna
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-11
Health check-in — day 7, dose 3
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-18
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-11-25
Survey response — day 21, dose 3
MedDRA: Dry eye, Eye pruritus, Lacrimation increased, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Intense itchy dry but watery eyes · Healthcare visit (other): In person appointment same day at normal eye doctor

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Report sent to call center — day 21, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-09
Survey response — day 35, dose 3
MedDRA: Dry eye, Eye pruritus, Lacrimation increased — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Dry itchy watery eyes that are not improving with steroid drops humidified no makeup etc

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Report sent to call center — day 35, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-10
Call 1 — Left Voicemail
2021-12-13
Call successful
Participant prefers to complete VAERS report online
2021-12-17
Survey response — day 42, dose 3
MedDRA: Dry eye, Eye pruritus — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Dry itchy eyes not improving with steroid drops and other at home remedies

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-21
Call 1 — Left Voicemail
2022-01-18
Call 1 — Left Voicemail
2022-05-07
Health check-in — 6 months, dose 3
Feeling: Poor

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Moderna
2	2021-04-07	Moderna
3	2021-11-04	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-10-06	Successful	Participant prefers to complete VAERS report online
2021-11-25	Unsuccessful
2021-12-09	Successful 2021-12-13	Participant prefers to complete VAERS report online
2021-12-17	Unsuccessful

Free text

Release 5 — day 0, dose 1

2021-03-10

Systemic reaction (other): Slight sense of disorientation/chest pain first 20 minutes after vaccine

Release 7 — day 14, dose 2

2021-04-21

Symptoms: This occurred during the first week but I forgot to include. Occasional and fleeting but sharp pains in both ears, occurring one ear at a time.

Release 10 — 6 months, dose 2

2021-10-06

Symptoms: Kidney infection/uti

Release 10 — day 21, dose 3

2021-11-25

Symptoms: Intense itchy dry but watery eyes

Healthcare visit (other): In person appointment same day at normal eye doctor

Release 10 — day 35, dose 3

2021-12-09

Symptoms: Dry itchy watery eyes that are not improving with steroid drops humidified no makeup etc

Release 10 — day 42, dose 3

2021-12-17

Symptoms: Dry itchy eyes not improving with steroid drops and other at home remedies

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	Office visit	·	·	✓
SD	Dry eye	·	·	✓
SD	Ear pain	✓	✓	✓
SD	Eye pruritus	·	·	✓
SD	Kidney infection	·	·	✓
SD	Lacrimation increased	·	·	✓
SD	Memory impairment	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Disorientation	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓

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