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ZM8-16140-09324

2 vaccinations 6 coded responses 14 check-ins 6 free-text entries 2 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
786 / TX
Registered
2021-02-23
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-21
    Dose 1 — Moderna
  2. 2021-02-23
    Registered in v-safe
  3. 2021-02-23
    Dose 2 — Moderna
  4. 2021-02-23
    Survey response — day 0, dose 2
    MedDRA: Autoimmune disorder — Feeling: Fair · Joint pains
    Free text: Autoimmune diseases
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-02-24
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities
    Adult check-in
  6. 2021-02-25
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness
    Adult check-in
  7. 2021-02-27
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Redness, Itching · Headache · Be unable to do your normal daily activities
    Adult check-in
  8. 2021-02-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · None
    Adult check-in
  9. 2021-03-01
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pre-existing disease — Feeling: Fair · Site: Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities
    Free text: I have 3 autoimmune diseases and migraines, so I have several of the above, but not from the vaccine.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-03-02
    Survey response — day 7, dose 2
    MedDRA: Migraine — Feeling: Good · Site: Itching · Chills, Headache
    Free text: It's just a migraine.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-03-11
    Health check-in — day 14, dose 2
    Feeling: Fair
    Adult check-in
  12. 2021-03-17
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  13. 2021-03-25
    Survey response — day 28, dose 2
    MedDRA: Asthenia, Chest pain, Dyspnoea, Headache — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Chest pain, weakness, shortness of breath, headache.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-03-30
    Health check-in — day 35, dose 2
    Feeling: Fair
    Adult check-in
  15. 2021-04-08
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-08-26
    Survey response — 6 months, dose 2
    MedDRA: Sepsis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit
    Free text: Intermediate sepsis of the feet/blood.
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  17. 2021-08-26
    Report sent to call center — 6 months, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  18. 2021-10-08
  19. 2022-02-27
    Survey response — 12 months, dose 2
    MedDRA: Chest pain, Disability, Dyspnoea, Gait inability, Headache, Heart rate decreased, Lymphoedema, Office visit, Staphylococcal infection — 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit
    Free text: Symptoms: Chest pain, shortness of breath, horrible headaches, lymphoedema, staph infection in legs, low heart rate, inability to walk. · Healthcare visit (other): Numerous doctor appointments, much new disability.
    MedDRA releases: 2024-11 · check-in free text available
  20. 2022-02-27
    Report sent to call center — 12 months, dose 2
    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 · 1 call case(s)
  21. 2022-03-01

Vaccinations

DoseDateManufacturerCo-administered
12021-01-21Moderna
22021-02-23Moderna

Call center

ReportedOutcomeVAERS-related outcome
2021-08-26 Unsuccessful
2022-02-27 Unsuccessful

Free text

Release 4 — day 0, dose 2

2021-02-23

Systemic reaction (other): Autoimmune diseases

Release 4 — days 1–6 daily, dose 2

2021-03-01

Systemic reaction (other): I have 3 autoimmune diseases and migraines, so I have several of the above, but not from the vaccine.

Release 4 — day 7, dose 2

2021-03-02

Systemic reaction (other): It's just a migraine.

Release 6 — day 28, dose 2

2021-03-25

Symptoms: Chest pain, weakness, shortness of breath, headache.

Release 9 — 6 months, dose 2

2021-08-26

Symptoms: Intermediate sepsis of the feet/blood.

Release 11 — 12 months, dose 2

2022-02-27

Symptoms: Chest pain, shortness of breath, horrible headaches, lymphoedema, staph infection in legs, low heart rate, inability to walk.
Healthcare visit (other): Numerous doctor appointments, much new disability.

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
HCVODisability · · ✓
HCVOOffice visit · · ✓
SDAsthenia ✓ ✓ ✓
SDChest pain ✓ ✓ ✓
SDDyspnoea ✓ ✓ ✓
SDGait inability · · ✓
SDHeadache ✓ ✓ ✓
SDHeart rate decreased · · ✓
SDLymphoedema · · ✓
SDSepsis ✓ · ✓
SDStaphylococcal infection · · ✓
SROAutoimmune disorder ✓ ✓ ✓
SROMigraine ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓

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