ZLA-20713-09968

3 vaccinations 8 coded responses 25 check-ins 8 free-text entries 4 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 391 / MS
Registered: 2021-03-09

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

2021-03-09
Registered in v-safe
2021-03-09
Dose 1 — Moderna
2021-03-09
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-11
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site nodule — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: 4 knots around the injection area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 1
MedDRA: Nodule — Feeling: Good · Site: Swelling · Fatigue or tiredness, Abdominal pain

Free text: Knots in arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — days 1–6 daily, dose 1
MedDRA: Dyspnoea — Feeling: Good · Fatigue or tiredness

Free text: Out of breathe during normal activities.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-23
Survey response — day 14, dose 1
MedDRA: Vaccination site mass, Vaccination site pain — Feeling: Good

Free text: My arm stills has several lumps and is tender around the vaccine area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-04-06
Dose 2 — Moderna
2021-04-06
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

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

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains

Adult check-in
2021-04-13
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to work

Adult check-in
2021-04-20
Survey response — day 14, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Psorasis breakout covering my body. My meds i have used for years are now ineffective.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-28
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-05-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-06
Survey response — 3 months, dose 2
MedDRA: Nausea, Vomiting — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Vomitting and nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-06
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-09
Call successful
Participant prefers to complete VAERS report online
2021-07-09
Call successful
Participant prefers to complete VAERS report online
2021-09-03
Dose 3 — Moderna
2021-10-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-03
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-03-04
Survey response — 6 months, dose 3
MedDRA: Dyspnoea, Fatigue — 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 · Outpatient clinic or urgent care clinic visit

Free text: Shortness of breathe, severe fatique

MedDRA releases: 2024-11 · check-in free text available
2022-03-04
Report sent to call center — 6 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-07
Call 1 — Left Voicemail
2022-09-03
Survey response — 12 months, dose 3
MedDRA: Amnesia, Fatigue, Lung disorder, Office visit, Wheezing — 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 · Outpatient clinic or urgent care clinic visit

Free text: 1. Weezing, according to my physician, its all over my lungs. 2. Fatigue, I always feel tired. 3. Memory, I have lost my sharp memory for short term and long term memories.

MedDRA releases: 2024-11 · check-in free text available
2022-09-03
Report sent to call center — 12 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-09-07
Call 2 — Could Not Reach Participant
2022-09-07
Call 1 — Could Not Reach Participant
2022-09-12
Call 2 — Could Not Reach Participant
2022-09-15
Call 3 — Could Not Reach Participant
2022-09-15
Call 3 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna
3	2021-09-03	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-20	Successful 2021-07-09	Participant prefers to complete VAERS report online
2021-07-06	Successful 2021-07-09	Participant prefers to complete VAERS report online
2022-03-04	Unsuccessful
2022-09-03	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-11

Systemic reaction (other): 4 knots around the injection area

2021-03-12

Systemic reaction (other): Knots in arm

2021-03-13

Systemic reaction (other): Out of breathe during normal activities.

Release 6 — day 14, dose 1

2021-03-23

Symptoms: My arm stills has several lumps and is tender around the vaccine area.

Release 7 — day 14, dose 2

2021-04-20

Symptoms: Psorasis breakout covering my body. My meds i have used for years are now ineffective.

Release 9 — 3 months, dose 2

2021-07-06

Symptoms: Vomitting and nausea

Release 11 — 6 months, dose 3

2022-03-04

Symptoms: Shortness of breathe, severe fatique

Release 12 — 12 months, dose 3

2022-09-03

Symptoms: 1. Weezing, according to my physician, its all over my lungs. 2. Fatigue, I always feel tired. 3. Memory, I have lost my sharp memory for short term and long term memories.

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	Amnesia	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Lung disorder	·	·	✓
SD	Nausea	✓	✓	✓
SD	Office visit	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Vaccination site mass	✓	✓	✓
SD	Vaccination site pain	✓	✓	✓
SD	Vomiting	✓	✓	✓
SD	Wheezing	·	·	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Injection site nodule	✓	✓	✓
SRO	Nodule	✓	✓	✓

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