ZMC-30643-01339

2 vaccinations 9 coded responses 16 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 726 / AR
Registered: 2021-03-16

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-03-09
Dose 1 — Moderna
2021-03-16
Registered in v-safe
2021-03-16
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-23
Survey response — day 14, dose 1
MedDRA: Diarrhoea — Feeling: Good · Be unable to do your normal daily activities

Free text: A diarrhea that was unexpected leaked without my bodily permission. A co- worker had the same shot the same time and her experience was with sudden cramps and she pooped her pants, she could not control it! We both were wondering if it was the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — day 21, dose 1
MedDRA: Abdominal pain upper — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe stomach cramps. Not sure, maybe a stomach bug I think.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Dose 2 — Moderna
2021-04-06
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Dry eye, Nasal dryness — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Dry nasal and dry eyes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · Fatigue or tiredness

Adult check-in
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Oropharyngeal pain, Seasonal allergy — Feeling: Fair

Free text: I have a sore throat and an ear-ache; could be seasonal hay fever.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Diarrhea

Adult check-in
2021-04-15
Survey response — day 7, dose 2
MedDRA: Palpitations — Feeling: Poor · Chills, Diarrhea · Be unable to work

Free text: I have noticed an increase of heart palpitations. This was before the news broadcasted Johnson&Johnson blood clot news; so I know the difference.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-05
Survey response — day 28, dose 2
MedDRA: Nasal congestion, Rhinorrhoea — Feeling: Good

Free text: Sniffles, head stuffy. Could have been allergies.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — day 35, dose 2
MedDRA: Ear pain, Headache, Neck pain — Feeling: Fair

Free text: New. My left side of my neck hurts, and my left ear. Headache too, on the left side. Could still be allergies.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — day 42, dose 2
MedDRA: Pain in extremity, Pain in jaw — Feeling: Good · Be unable to do your normal daily activities

Free text: Left arm sore, and left side jaw and gland area sore. I would have gone in to Dr. but other people in our community experienced same symptoms. One other had COVID 18 vacc, the other didnt. Just curious...;(

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-04-06
Survey response — 12 months, dose 2
MedDRA: Palpitations, Pre-existing disease, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Hmm, well I will see my physician tomorrowmy heart periodically makes a "galumping' sensation. I have had palpitations before, but this is 'galumping heavy thudding if my heart' weird. · Healthcare visit (other): In office; tomorrow.

MedDRA releases: 2024-11 · check-in free text available
2022-04-06
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

1 call case(s)
2022-04-11
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2022-04-06	Unsuccessful

Free text

Release 6 — day 14, dose 1

2021-03-23

Symptoms: A diarrhea that was unexpected leaked without my bodily permission. A co- worker had the same shot the same time and her experience was with sudden cramps and she pooped her pants, she could not control it! We both were wondering if it was the shot cut off by CDC

Release 6 — day 21, dose 1

2021-03-30

Symptoms: Severe stomach cramps. Not sure, maybe a stomach bug I think.

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Dry nasal and dry eyes

2021-04-11

Systemic reaction (other): I have a sore throat and an ear-ache; could be seasonal hay fever.

Release 7 — day 7, dose 2

2021-04-15

Systemic reaction (other): I have noticed an increase of heart palpitations. This was before the news broadcasted Johnson&Johnson blood clot news; so I know the difference.

Release 8 — day 28, dose 2

2021-05-05

Symptoms: Sniffles, head stuffy. Could have been allergies.

Release 8 — day 35, dose 2

2021-05-11

Symptoms: New. My left side of my neck hurts, and my left ear. Headache too, on the left side. Could still be allergies.

Release 8 — day 42, dose 2

2021-05-20

Symptoms: Left arm sore, and left side jaw and gland area sore. I would have gone in to Dr. but other people in our community experienced same symptoms. One other had COVID 18 vacc, the other didnt. Just curious...;(

Release 11 — 12 months, dose 2

2022-04-06

Symptoms: Hmm, well I will see my physician tomorrowmy heart periodically makes a "galumping' sensation. I have had palpitations before, but this is 'galumping heavy thudding if my heart' weird.

Healthcare visit (other): In office; tomorrow.

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	Unevaluable event	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Ear pain	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Nasal congestion	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pain in jaw	✓	✓	✓
SD	Palpitations	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Dry eye	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Nasal dryness	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Palpitations	✓	✓	✓
SRO	Seasonal allergy	✓	✓	✓

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