ZM9-77463-23800

4 vaccinations 10 coded responses 45 check-ins 10 free-text entries 3 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 217 / MD
Registered: 2021-04-05

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

3WE-27044-23362 Child or adolescent in my care · Female · 2021-11-18

525-11782-68522 Child or adolescent in my care · Female · 2021-11-18

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-05
Registered in v-safe
2021-04-05
Dose 1 — Moderna
2021-04-05
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-04-06
Survey response — days 1–6 daily, dose 1
MedDRA: Periorbital swelling — Feeling: Good

Free text: Woke up with puffy allergy eyes, not my usual seasonal allergy response

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Pre-existing disease, Rheumatoid arthritis — Feeling: Good · Joint pains

Free text: Joint pain possibly due to RA flare

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-09
Survey response — days 1–6 daily, dose 1
MedDRA: Rheumatoid arthritis — Feeling: Fair · Joint pains

Free text: Due to RA flare.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — days 1–6 daily, dose 1
MedDRA: Arthritis, Pre-existing disease, Rheumatoid arthritis — Feeling: Fair · Joint pains

Free text: Mild RA flair

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 1
MedDRA: Rheumatoid arthritis — Feeling: Poor · Joint pains · Be unable to do your normal daily activities

Free text: Severe RA flare

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — day 7, dose 1
MedDRA: Pre-existing disease, Rheumatoid arthritis — Feeling: Fair · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: RA flare

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-03
Dose 2 — Moderna
2021-05-03
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Joint pains, Fatigue or tiredness

Adult check-in
2021-05-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-10
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-24
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-10
Dose 3 — Moderna
2021-11-18
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-24
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-22
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-09
Survey response — 3 months, dose 3
MedDRA: Autoimmune disorder, Cough, Fatigue, Respiratory tract congestion, SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend school

Free text: Tested positive for Covid and had light symptoms. Cough, congestion, tiredness. Plus autoimmune issues.

MedDRA releases: 2024-11 · check-in free text available
2022-05-11
Survey response — 6 months, dose 3
MedDRA: Bronchitis, Chest discomfort, Dyspnoea, Upper-airway cough syndrome — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Had bronchitis for two weeks. Shortness of breath, tight chest, constant postnasal drip

MedDRA releases: 2024-11 · check-in free text available
2022-05-11
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-12
Call 2 — Left Voicemail
2022-07-02
Dose 4 — Moderna
2022-07-04
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-07-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling, Itching · None

Adult check-in
2022-07-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2022-07-07
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-07-09
Health check-in — day 7, dose 4
Feeling: Good · Site: Swelling, Itching · None

Adult check-in
2022-07-16
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-07-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-07-30
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-08-07
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-08-13
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-10-01
Survey response — 3 months, dose 4
MedDRA: Arthralgia, Hypermobility syndrome, Office visit, Physiotherapy — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Joint pain diagnosed as hypermobility. Gets worse with cooler, wet weather. · Healthcare visit (other): In person specialist visit and physical therapy

MedDRA releases: 2024-11 · check-in free text available
2022-10-01
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

1 call case(s)
2022-10-03
Call 3 — Left Voicemail
2022-10-03
Call 2 — Left Voicemail
2022-12-31
Survey response — 6 months, dose 4
MedDRA: Bronchitis, Office visit, Pneumonia, Productive cough, Respiratory tract congestion, Upper-airway cough syndrome — 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

Free text: Symptoms: Combo bronchitis/pneumonia Wet productive cough, chest congestion, post nasal drip · Healthcare visit (other): In person primary care physician

MedDRA releases: 2024-11 · check-in free text available
2022-12-31
Report sent to call center — 6 months, 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

1 call case(s)
2023-01-03
Call 1 — Requested Callback
2023-01-03
Call 1 — Requested Callback
2023-01-03
Call 1 — Requested Callback
2023-01-03
Callback requested for
02:15PM ET
2023-01-03
Call successful
Not applicable - Accidental Reporting
2023-01-03
Call successful
Not applicable - Accidental Reporting
2023-01-03
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-05	Moderna
2	2021-05-03	Moderna
3	2021-11-10	Moderna	No
4	2022-07-02	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-11	Successful 2023-01-03	Not applicable - Accidental Reporting
2022-10-01	Successful 2023-01-03	Not applicable - Accidental Reporting
2022-12-31	Successful 2023-01-03	Not applicable - Accidental Reporting

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-06

Systemic reaction (other): Woke up with puffy allergy eyes, not my usual seasonal allergy response

2021-04-07

Systemic reaction (other): Joint pain possibly due to RA flare

2021-04-09

Systemic reaction (other): Due to RA flare.

2021-04-10

Systemic reaction (other): Mild RA flair

2021-04-11

Systemic reaction (other): Severe RA flare

Release 7 — day 7, dose 1

2021-04-12

Systemic reaction (other): RA flare

Release 11 — 3 months, dose 3

2022-02-09

Symptoms: Tested positive for Covid and had light symptoms. Cough, congestion, tiredness. Plus autoimmune issues.

Release 11 — 6 months, dose 3

2022-05-11

Symptoms: Had bronchitis for two weeks. Shortness of breath, tight chest, constant postnasal drip

Release 12 — 3 months, dose 4

2022-10-01

Symptoms: Joint pain diagnosed as hypermobility. Gets worse with cooler, wet weather.

Healthcare visit (other): In person specialist visit and physical therapy

Release 12 — 6 months, dose 4

2022-12-31

Symptoms: Combo bronchitis/pneumonia Wet productive cough, chest congestion, post nasal drip

Healthcare visit (other): In person primary care physician

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	·	·	✓
HCVO	Physiotherapy	·	·	✓
SD	Arthralgia	·	·	✓
SD	Autoimmune disorder	·	·	✓
SD	Bronchitis	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Cough	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypermobility syndrome	·	·	✓
SD	Pneumonia	·	·	✓
SD	Productive cough	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Upper-airway cough syndrome	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Arthritis	✓	✓	✓
SRO	Periorbital swelling	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rheumatoid arthritis	✓	✓	✓

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