ZMG-24892-89016

4 vaccinations 13 coded responses 54 check-ins 13 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 452 / OH
Registered: 2021-02-04

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

2021-02-04
Registered in v-safe
2021-02-04
Dose 1 — Moderna
2021-02-04
Survey response — day 0, dose 1
MedDRA: Flushing — Feeling: Good

Free text: My face flushed beet red 20 minutes after when I returned to my car. That subsided in 10 minutes. No fever when I took it 1 hr after the shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · None

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

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

Adult check-in
2021-02-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-04
Survey response — day 28, dose 1
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair

Free text: Flare up of auto immune lichen schlerosis started flaring up 1 week post vaccine but may not be related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Dose 2 — Moderna
2021-03-06
Survey response — day 0, dose 2
MedDRA: Body temperature decreased, Erythema, Flushing, Immediate post-injection reaction — Feeling: Good · Site: Pain

Free text: Face flushed bright red at the facility at10 min with temp from 96.8 to 98.2 then lessened but still small amount facial flushing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-03-13
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-20
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-28
Survey response — day 21, dose 2
MedDRA: Head injury, Headache — Feeling: Good

Free text: Headaches after hitting my head hard.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-10
Survey response — day 35, dose 2
MedDRA: Head injury, Headache, SARS-CoV-2 test negative, Unevaluable event — 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: Bad headaches. Concussion? From hitting my head 3/22(Had neg Covid-19 pre op test on Friday) · Healthcare visit (other): Will see md Monday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
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)
2021-04-17
Survey response — day 42, dose 2
MedDRA: Office visit, Post concussion syndrome, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Headaches continue/ post concussion syndrome no head bleed · Healthcare visit (other): Md visit CTand X-rays covid test from 4/9 neg

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-17
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-05
Survey response — 3 months, dose 2
MedDRA: Concussion, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Concussion · Healthcare visit (other): Office visits

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-05
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-04
Survey response — 6 months, dose 2
MedDRA: Headache, Oropharyngeal pain — Feeling: Good

Free text: Slight Sore throat and slight headache 24 hrs a couple days ago.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-03
Dose 3 — Moderna
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-05
Survey response — days 1–6 daily, dose 3
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Worst yesterday after v check in

MedDRA releases: 2024-11 · check-in free text available
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Headache, Muscle or body aches

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-11-12
Survey response — day 7, dose 3
MedDRA: Corneal transplant, Intraocular pressure increased, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Increased intraocular pressure. (I have had corneal transplantation and take steroid eye drops) · Healthcare visit (other): Saw ophthalmologists and my corneal specialist will follow up next week after adjusting eyemeds

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Report sent to call center — day 7, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-15
Call 1 — Left Voicemail
2021-11-16
Call successful
Participant prefers to complete VAERS report online
2021-11-17
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-24
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-08
Survey response — 6 months, dose 3
MedDRA: Pyrexia, SARS-CoV-2 test negative, Viral infection — Feeling: Good · Be unable to do your normal daily activities

Free text: Bad virus 3 weeks with fever neg Covid test

MedDRA releases: 2024-11 · check-in free text available
2022-09-30
Dose 4 — Moderna
2022-10-01
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-02
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-03
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Fatigue or tiredness

Adult check-in
2022-10-04
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-06
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2022-10-07
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-10-14
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-21
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-28
Survey response — day 28, dose 4
MedDRA: Urinary tract infection — Feeling: Good

Free text: Uti

MedDRA releases: 2024-11 · check-in free text available
2022-11-04
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-11
Survey response — day 42, dose 4
MedDRA: Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Continue to have more fatigue than I expect since booster with activity

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-03-31
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-06	Moderna
3	2021-11-03	Moderna	No
4	2022-09-30	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-10	Successful	Participant prefers to complete VAERS report online
2021-04-17	Successful	Participant prefers to complete VAERS report online
2021-06-05	Successful	Participant prefers to complete VAERS report online
2021-11-12	Successful 2021-11-16	Participant prefers to complete VAERS report online

Free text

Release 3 — day 0, dose 1

2021-02-04

Systemic reaction (other): My face flushed beet red 20 minutes after when I returned to my car. That subsided in 10 minutes. No fever when I took it 1 hr after the shot

Release 5 — day 28, dose 1

2021-03-04

Symptoms: Flare up of auto immune lichen schlerosis started flaring up 1 week post vaccine but may not be related.

Release 5 — day 0, dose 2

2021-03-06

Systemic reaction (other): Face flushed bright red at the facility at10 min with temp from 96.8 to 98.2 then lessened but still small amount facial flushing

Release 6 — day 21, dose 2

2021-03-28

Symptoms: Headaches after hitting my head hard.

Release 7 — day 35, dose 2

2021-04-10

Symptoms: Bad headaches. Concussion? From hitting my head 3/22(Had neg Covid-19 pre op test on Friday)

Healthcare visit (other): Will see md Monday

Release 7 — day 42, dose 2

2021-04-17

Symptoms: Headaches continue/ post concussion syndrome no head bleed

Healthcare visit (other): Md visit CTand X-rays covid test from 4/9 neg

Release 8 — 3 months, dose 2

2021-06-05

Symptoms: Concussion

Healthcare visit (other): Office visits

Release 9 — 6 months, dose 2

2021-09-04

Symptoms: Slight Sore throat and slight headache 24 hrs a couple days ago.

Release 10 — days 1–6 daily, dose 3

2021-11-05

Systemic reaction (other): Worst yesterday after v check in

Release 10 — day 7, dose 3

2021-11-12

Systemic reaction (other): Increased intraocular pressure. (I have had corneal transplantation and take steroid eye drops)

Healthcare visit (other): Saw ophthalmologists and my corneal specialist will follow up next week after adjusting eyemeds

Release 11 — 6 months, dose 3

2022-05-08

Symptoms: Bad virus 3 weeks with fever neg Covid test

Release 12 — day 28, dose 4

2022-10-28

Symptoms: Uti

Release 12 — day 42, dose 4

2022-11-11

Symptoms: Continue to have more fatigue than I expect since booster with activity

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	SARS-CoV-2 test negative	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Concussion	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Fatigue	·	·	✓
SD	Head injury	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Oropharyngeal pain	✓	·	✓
SD	Post concussion syndrome	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SD	Viral infection	·	·	✓
SRO	Adverse reaction	·	·	✓
SRO	Body temperature decreased	✓	✓	✓
SRO	Corneal transplant	·	·	✓
SRO	Erythema	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Intraocular pressure increased	·	·	✓

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