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ZL7-27744-45084

4 vaccinations 9 coded responses 37 check-ins 9 free-text entries 5 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
329 / FL
Registered
2021-01-20
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-16
    Dose 1 — Moderna
  2. 2021-01-20
    Registered in v-safe
  3. 2021-01-24
    Health check-in — day 7, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  4. 2021-01-30
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  5. 2021-02-06
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  6. 2021-02-13
    Dose 2 — Moderna
  7. 2021-02-13
    Health check-in — day 0, dose 2
    Feeling: Good · Site: Pain · Fatigue or tiredness
    Adult check-in
  8. 2021-02-14
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  9. 2021-02-15
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · None
    Adult check-in
  10. 2021-02-16
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pelvic pain — Feeling: Good
    Free text: Pelvic pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-02-17
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pelvic pain — Feeling: Good
    Free text: Pelvic pain moderate
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-02-18
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pelvic pain — Feeling: Good · Headache
    Free text: Mild pelvic pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-02-19
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Headache
    Adult check-in
  14. 2021-02-20
    Health check-in — day 7, dose 2
    Feeling: Good · Headache
    Adult check-in
  15. 2021-02-27
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-03-06
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-03-13
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-03-20
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  19. 2021-03-27
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-05-15
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-10-26
    Dose 3 — Moderna
  22. 2021-10-27
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Swelling · Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  23. 2021-10-28
    Health check-in — days 1–6 daily, dose 3
    Feeling: Poor · Site: Swelling, Itching · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  24. 2021-10-29
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Swelling, Itching · None
    Adult check-in
  25. 2021-10-30
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Swelling, Itching · None
    Adult check-in
  26. 2021-10-31
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Itching · None
    Adult check-in
  27. 2021-11-01
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  28. 2021-11-03
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  29. 2021-11-09
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  30. 2021-11-16
    Survey response — day 21, dose 3
    MedDRA: Body temperature increased, Nasopharyngitis, Oropharyngeal pain — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Head cold and low grade temperature and sore throat for past 3 days
    MedDRA releases: 2024-11 · check-in free text available
  31. 2021-11-23
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  32. 2021-11-30
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  33. 2021-12-07
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  34. 2022-01-27
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  35. 2022-04-26
    Survey response — 6 months, dose 3
    MedDRA: Influenza, Sinusitis — Feeling: Good · 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: Flu and sinus infection
    MedDRA releases: 2024-11 · check-in free text available
  36. 2022-04-26
    Report sent to call center — 6 months, dose 3
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  37. 2022-04-28
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  38. 2022-05-05
    Dose 4 — Moderna
  39. 2022-05-19
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  40. 2022-05-26
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  41. 2022-06-04
    Survey response — day 28, dose 4
    MedDRA: Arthralgia, Headache, Neck pain, Pain in jaw, Pre-existing disease — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: Symptoms: Headaches neck jaw and right hip pain · Healthcare visit (other): Possibly related to new drug, Risedronate, I take for osteoporosis
    MedDRA releases: 2024-11 · check-in free text available
  42. 2022-06-04
    Report sent to call center — day 28, dose 4
    Get care from a doctor or other healthcare professional
    Telehealth, virtual health, or email health consultation · 1 call case(s)
  43. 2022-06-06
    Call successful
    Participant prefers to complete VAERS report online
  44. 2022-06-12
    Survey response — day 35, dose 4
    MedDRA: Hospitalisation, Pericardial effusion, Pericardial excision, Sinusitis, Surgery, Viral upper respiratory 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 · Emergency room or emergency department visit, Hospitalization
    Free text: Symptoms: Hospitalized for Pericardium infusion window surgery to remove bloody fluid in the pericardium. Biopsy not conclusive as to the cause. Had upper respiratory virus and sinus inflection 1 and half months prior. · Healthcare visit (other): Surgery
    MedDRA releases: 2024-11 · check-in free text available
  45. 2022-06-12
    Report sent to call center — day 35, dose 4
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Emergency room or emergency department visit · Hospitalization · 1 call case(s)
  46. 2022-06-13
    Call successful
    Participant prefers to complete VAERS report online
  47. 2022-06-18
    Survey response — day 42, dose 4
    MedDRA: Pneumonia — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit
    Free text: Pneumonia lower left lobe
    MedDRA releases: 2024-11 · check-in free text available
  48. 2022-06-18
    Report sent to call center — day 42, dose 4
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    Emergency room or emergency department visit · 1 call case(s)
  49. 2022-06-21
    Call successful
    Participant prefers to complete VAERS report online
  50. 2022-08-05
    Survey response — 3 months, dose 4
    MedDRA: Hospitalisation, Pericardial effusion, Pleural effusion, Post procedural drainage, Post procedural pneumonia, Surgery — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization
    Free text: Hospitalized and operated on for pericardium effusion. After surgery developed pneumonia and water on lung which had to be drained.
    MedDRA releases: 2024-11 · check-in free text available
  51. 2022-08-05
    Report sent to call center — 3 months, dose 4
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    Emergency room or emergency department visit · Hospitalization · 1 call case(s)
  52. 2022-08-08
    Call successful
    Participant prefers to complete VAERS report online

Vaccinations

DoseDateManufacturerCo-administered
12021-01-16Moderna
22021-02-13Moderna
32021-10-26Moderna No
42022-05-05Moderna No

Call center

ReportedOutcomeVAERS-related outcome
2022-04-26 Successful
2022-04-28
 Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-04 Successful
2022-06-06
 Participant prefers to complete VAERS report online
2022-06-12 Successful
2022-06-13
 Participant prefers to complete VAERS report online
2022-06-18 Successful
2022-06-21
 Participant prefers to complete VAERS report online
2022-08-05 Successful
2022-08-08
 Participant prefers to complete VAERS report online

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-16

Systemic reaction (other): Pelvic pain

2021-02-17

Systemic reaction (other): Pelvic pain moderate

2021-02-18

Systemic reaction (other): Mild pelvic pain

Release 10 — day 21, dose 3

2021-11-16

Symptoms: Head cold and low grade temperature and sore throat for past 3 days

Release 11 — 6 months, dose 3

2022-04-26

Symptoms: Flu and sinus infection

Release 11 — day 28, dose 4

2022-06-04

Symptoms: Headaches neck jaw and right hip pain
Healthcare visit (other): Possibly related to new drug, Risedronate, I take for osteoporosis

Release 12 — day 35, dose 4

2022-06-12

Symptoms: Hospitalized for Pericardium infusion window surgery to remove bloody fluid in the pericardium. Biopsy not conclusive as to the cause. Had upper respiratory virus and sinus inflection 1 and half months prior.
Healthcare visit (other): Surgery

Release 12 — day 42, dose 4

2022-06-18

Symptoms: Pneumonia lower left lobe

Release 12 — 3 months, dose 4

2022-08-05

Symptoms: Hospitalized and operated on for pericardium effusion. After surgery developed pneumonia and water on lung which had to be drained.

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

FieldPreferred term2021-092023-042024-11
HCVOPre-existing disease · · ✓
HCVOSurgery · · ✓
SDArthralgia · · ✓
SDBody temperature increased · · ✓
SDHeadache · · ✓
SDHospitalisation · · ✓
SDInfluenza · · ✓
SDNasopharyngitis · · ✓
SDNeck pain · · ✓
SDOropharyngeal pain · · ✓
SDPain in jaw · · ✓
SDPericardial effusion · · ✓
SDPericardial excision · · ✓
SDPleural effusion · · ✓
SDPneumonia · · ✓
SDPost procedural drainage · · ✓
SDPost procedural pneumonia · · ✓
SDSinusitis · · ✓
SDSurgery · · ✓
SDViral upper respiratory tract infection · · ✓
SROPelvic pain ✓ ✓ ✓

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

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