ZLF-29511-79489

3 vaccinations 8 coded responses 29 check-ins 8 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 327 / FL
Registered: 2021-01-08

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

2021-01-07
Dose 1 — Moderna
2021-01-08
Registered in v-safe
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-01-14
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-01-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Dose 2 — Moderna
2021-02-04
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction, Unevaluable event — Feeling: Fair · Headache, Muscle or body aches

Free text: I havent taken advil so i think the symptoms seem harder to take this time

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
Survey response — day 14, dose 2
MedDRA: Cough, Fatigue, Headache, Respiratory tract congestion — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Chest congestion, coughing , headache, tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-13
Survey response — day 35, dose 2
MedDRA: Nasopharyngitis, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

Free text: Cold and chest congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-07
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-09
Call 1 — Left Voicemail
2021-10-07
Dose 3 — Moderna
2021-10-25
Survey response — day 14, dose 3
MedDRA: Nasopharyngitis — Feeling: Fair

Free text: I have a cold

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — day 21, dose 3
MedDRA: Bronchitis, Nasopharyngitis — Feeling: Fair

Free text: Cold and bronchitis

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-11-11
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-20
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-06
Survey response — 3 months, dose 3
MedDRA: Fatigue, Headache — Feeling: Fair

Free text: Very very tired, headache for days

MedDRA releases: 2024-11 · check-in free text available
2022-04-07
Survey response — 6 months, dose 3
MedDRA: Bronchitis, Malaise — Feeling: Poor · 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

Free text: Symptoms: Bronchitis.....then violently ill from steroids and antibiotics · Healthcare visit (other): My primary physician refused to take care of my bronchitis because of it being a respiratory disease and COVID . I offer to go get tested and bring in the results but they said Said no go to an emergency room.

MedDRA releases: 2024-11 · check-in free text available
2022-04-07
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

Emergency room or emergency department visit · 1 call case(s)
2022-05-04
Call 1 — Could Not Reach Participant
2022-05-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-07
Survey response — 12 months, dose 3
MedDRA: Bronchitis — 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, Outpatient clinic or urgent care clinic visit

Free text: Bronchitis

MedDRA releases: 2024-11 · check-in free text available
2022-10-07
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

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-04	Moderna
3	2021-10-07	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-02-18	Successful 2022-05-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-04-07	Successful 2022-05-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-07	Successful 2022-10-10	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): I havent taken advil so i think the symptoms seem harder to take this time

Release 4 — day 14, dose 2

2021-02-18

Symptoms: Chest congestion, coughing , headache, tired

Release 5 — day 35, dose 2

2021-03-13

Symptoms: Cold and chest congestion

Release 10 — day 14, dose 3

2021-10-25

Symptoms: I have a cold

Release 10 — day 21, dose 3

2021-10-28

Symptoms: Cold and bronchitis

Release 10 — 3 months, dose 3

2022-01-06

Symptoms: Very very tired, headache for days

Release 11 — 6 months, dose 3

2022-04-07

Symptoms: Bronchitis.....then violently ill from steroids and antibiotics

Healthcare visit (other): My primary physician refused to take care of my bronchitis because of it being a respiratory disease and COVID . I offer to go get tested and bring in the results but they said Said no go to an emergency room.

Release 12 — 12 months, dose 3

2022-10-07

Symptoms: Bronchitis

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	Bronchitis	·	·	✓
SD	Bronchitis	·	·	✓
SD	Cough	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Malaise	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SRO	Adverse reaction	·	·	✓
SRO	Unevaluable event	✓	✓	○

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