ZLX-15036-18000

4 vaccinations 17 coded responses 41 check-ins 17 free-text entries 7 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 554 / MN
Registered: 2021-03-21

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

2021-03-20
Dose 1 — Moderna
2021-03-21
Registered in v-safe
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Fair · Fatigue or tiredness

Free text: Sore Throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-27
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-17
Dose 2 — Moderna
2021-04-17
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-25
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-01
Survey response — day 14, dose 2
MedDRA: Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Unusual fatigue.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Survey response — day 21, dose 2
MedDRA: Nasal congestion, Sneezing — Feeling: Fair

Free text: Stuffy nose, sneezing... pretty sure its a spring cold.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-23
Survey response — day 35, dose 2
MedDRA: Fatigue, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Diagnosed with iron deficient anemia. Im extremely tired all the time. · Healthcare visit (other): Lab visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-31
Survey response — day 42, dose 2
MedDRA: Iron deficiency, Iron deficiency anaemia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Iron deficient anemia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-17
Survey response — 3 months, dose 2
MedDRA: Iron deficiency anaemia, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities

Free text: Iron deficient anemia on May 21, 2021. Probably due to kidney disease, appendix surgery in Feb 2021, and having covid in October 2020.

MedDRA releases: 2024-11 · check-in free text available
2021-10-16
Survey response — 6 months, dose 2
MedDRA: Ear infection, Furuncle, Infection, Urinary tract infection — Feeling: Good · 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: Ear infection, UTI, infected boil

MedDRA releases: 2024-11 · check-in free text available
2021-10-16
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-19
Call 2 — Left Voicemail
2021-12-23
Dose 3 — Moderna
2021-12-23
Health check-in — day 0, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-12-24
Survey response — days 1–6 daily, dose 3
MedDRA: Dyspnoea — Feeling: Fair · Fatigue or tiredness

Free text: Increased shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-12-25
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Dyspnoea — Feeling: Fair

Free text: Cough, shortness of breath

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Survey response — days 1–6 daily, dose 3
MedDRA: Cough — Feeling: Fair

Free text: Cough

MedDRA releases: 2024-11 · check-in free text available
2021-12-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-30
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-01-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-28
Survey response — day 35, dose 3
MedDRA: Cough, Dyspnoea, Emergency care, Pneumonia — Feeling: Poor · 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: Persistent cough for a week, and shortness of breath. Diagnosed an hour ago in the ER with pneumonia. Starting antibiotics.

MedDRA releases: 2024-11 · check-in free text available
2022-01-28
Report sent to call center — day 35, dose 3
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)
2022-01-31
Call 1 — Left Voicemail
2022-02-03
Call successful
Not applicable - Accidental Reporting
2022-02-03
Call successful
Not applicable - Accidental Reporting
2022-02-06
Survey response — day 42, dose 3
MedDRA: Hospitalisation, Pneumonia bacterial — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Bacterial pneumonia hospitalization

MedDRA releases: 2024-11 · check-in free text available
2022-02-06
Report sent to call center — day 42, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Hospitalization · 1 call case(s)
2022-02-14
Call successful
Not applicable - Accidental Reporting
2022-03-27
Survey response — 3 months, dose 3
MedDRA: Hospitalisation, Pneumonia — 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: Non-COVID Pneumonia- 10 day hospital stay

MedDRA releases: 2024-11 · check-in free text available
2022-03-27
Report sent to call center — 3 months, dose 3
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)
2022-03-30
Call successful
Does not wish to fill out VAERS report
2022-06-24
Survey response — 6 months, dose 3
MedDRA: Back pain, Hypoaesthesia, Paraesthesia — 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: Back pain, numbness and tingling in left hand.

MedDRA releases: 2024-11 · check-in free text available
2022-06-24
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)
2022-06-24
Call 1 — Left Voicemail
2022-06-24
Call 1 — Left Voicemail
2022-06-24
Call 2 — Left Voicemail
2022-06-24
Call 1 — Left Voicemail
2022-06-24
Call 1 — Left Voicemail
2022-06-24
Call 1 — Left Voicemail
2022-10-31
Dose 4 — Pfizer-BioNTech
Co-administered: Flu
2022-11-16
Survey response — day 14, dose 4
MedDRA: Upper respiratory tract infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Day after receivig my flu and Covid vaccine I developed an upper respiratory infection. I'm pretty sure it was not related to the vaccines.

MedDRA releases: 2024-11 · check-in free text available
2022-11-23
Survey response — day 21, dose 4
MedDRA: Hospitalisation, Pneumonia, Syncope — Feeling: Poor · Be unable to do your normal daily activities

Free text: I fainted on Monday night, was admitted to hospital with pneumonia.

MedDRA releases: 2024-11 · check-in free text available
2022-12-16
Survey response — day 42, dose 4
MedDRA: Dyspnoea, Fluid retention, Hospitalisation — Feeling: Poor · 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: I'm having issues with fluid retention and shortness of breath. I'm currently in the hospital.

MedDRA releases: 2024-11 · check-in free text available
2022-12-16
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 · Hospitalization · 1 call case(s)
2022-12-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-01
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-05-01
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-20	Moderna
2	2021-04-17	Moderna
3	2021-12-23	Moderna	No
4	2022-10-31	Pfizer-BioNTech	Flu

Call center

Reported	Outcome	VAERS-related outcome
2021-05-23	Successful	Not applicable - Accidental Reporting
2021-10-16	Successful 2022-02-03	Not applicable - Accidental Reporting
2022-01-28	Successful 2022-02-03	Not applicable - Accidental Reporting
2022-02-06	Successful 2022-02-14	Not applicable - Accidental Reporting
2022-03-27	Successful 2022-03-30	Does not wish to fill out VAERS report
2022-06-24	Successful 2022-12-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-16	Successful 2022-12-19	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-22

Systemic reaction (other): Sore Throat

Release 8 — day 14, dose 2

2021-05-01

Symptoms: Unusual fatigue.

Release 8 — day 21, dose 2

2021-05-08

Symptoms: Stuffy nose, sneezing... pretty sure its a spring cold.

Release 8 — day 35, dose 2

2021-05-23

Symptoms: Diagnosed with iron deficient anemia. Im extremely tired all the time.

Healthcare visit (other): Lab visit

Release 8 — day 42, dose 2

2021-05-31

Symptoms: Iron deficient anemia

Release 9 — 3 months, dose 2

2021-07-17

Symptoms: Iron deficient anemia on May 21, 2021. Probably due to kidney disease, appendix surgery in Feb 2021, and having covid in October 2020.

Release 10 — 6 months, dose 2

2021-10-16

Symptoms: Ear infection, UTI, infected boil

Release 10 — days 1–6 daily, dose 3

2021-12-24

Systemic reaction (other): Increased shortness of breath

2021-12-25

Systemic reaction (other): Cough, shortness of breath

2021-12-26

Systemic reaction (other): Cough

Release 11 — day 35, dose 3

2022-01-28

Symptoms: Persistent cough for a week, and shortness of breath. Diagnosed an hour ago in the ER with pneumonia. Starting antibiotics.

Release 11 — day 42, dose 3

2022-02-06

Symptoms: Bacterial pneumonia hospitalization

Release 11 — 3 months, dose 3

2022-03-27

Symptoms: Non-COVID Pneumonia- 10 day hospital stay

Release 12 — 6 months, dose 3

2022-06-24

Symptoms: Back pain, numbness and tingling in left hand.

Release 12 — day 14, dose 4

2022-11-16

Symptoms: Day after receivig my flu and Covid vaccine I developed an upper respiratory infection. I'm pretty sure it was not related to the vaccines.

Release 12 — day 21, dose 4

2022-11-23

Symptoms: I fainted on Monday night, was admitted to hospital with pneumonia.

Release 12 — day 42, dose 4

2022-12-16

Symptoms: I'm having issues with fluid retention and shortness of breath. I'm currently in the hospital.

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	Back pain	·	·	✓
SD	Cough	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Ear infection	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Fluid retention	·	·	✓
SD	Furuncle	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Infection	·	·	✓
SD	Iron deficiency	✓	✓	○
SD	Iron deficiency anaemia	·	·	✓
SD	Nasal congestion	✓	✓	✓
SD	Paraesthesia	·	·	✓
SD	Pneumonia	·	·	✓
SD	Pneumonia bacterial	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sneezing	✓	✓	✓
SD	Syncope	·	·	✓
SD	Upper respiratory tract infection	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Cough	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Oropharyngeal pain	✓	✓	✓

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