ZMH-20623-27014

3 vaccinations 4 coded responses 37 check-ins 4 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 385 / TN
Registered: 2021-02-26

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

Timeline

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

2021-02-26
Registered in v-safe
2021-02-26
Dose 1 — Moderna
2021-02-26
Health check-in — day 0, dose 1
Feeling: Good · Fever · None

Adult check-in
2021-02-27
Survey response — days 1–6 daily, dose 1
MedDRA: Musculoskeletal stiffness — Feeling: Good · Site: Pain

Free text: Mild stiffness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-29
Dose 2 — Moderna
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Abdominal pain

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

Adult check-in
2021-04-05
Health check-in — day 7, dose 2
Feeling: Fair · Joint pains

Adult check-in
2021-04-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-03
Survey response — day 35, dose 2
MedDRA: Abdominal discomfort, Abdominal pain upper, Nausea — Feeling: Good

Free text: Sensitive stomach symptoms ... kinda achey/ nausea in my gut.... have to make sure I eat upon waking up.... and make sure I take thyroid tab upon waking up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fever · Headache

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Eye pain — Feeling: Good · Site: Pain, Swelling · Headache

Free text: My left eye was sore to touch

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Health check-in — day 7, dose 3
Feeling: Good · None

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

Adult check-in
2021-11-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-24
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-26
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-27
Survey response — 6 months, dose 3
MedDRA: Blister, Drug hypersensitivity, Rash, Sinusitis, Swelling face, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sinus infection requiring antibiotic amoxicillin that cleared up the infection but resulted in a severe allergic reaction: swollen face, rash, hives, blisters to the antibiotic. This was documented with my PCP took a week to recover.

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
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)
2022-05-02
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-27
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-26	Moderna
2	2021-03-29	Moderna
3	2021-10-27	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-04-27	Successful 2022-05-02	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-27

Systemic reaction (other): Mild stiffness

Release 8 — day 35, dose 2

2021-05-03

Symptoms: Sensitive stomach symptoms ... kinda achey/ nausea in my gut.... have to make sure I eat upon waking up.... and make sure I take thyroid tab upon waking up

Release 10 — days 1–6 daily, dose 3

2021-10-30

Systemic reaction (other): My left eye was sore to touch

Release 11 — 6 months, dose 3

2022-04-27

Symptoms: Sinus infection requiring antibiotic amoxicillin that cleared up the infection but resulted in a severe allergic reaction: swollen face, rash, hives, blisters to the antibiotic. This was documented with my PCP took a week to recover.

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
SD	Abdominal discomfort	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Blister	·	·	✓
SD	Drug hypersensitivity	·	·	✓
SD	Nausea	✓	✓	✓
SD	Rash	·	·	✓
SD	Sinusitis	·	·	✓
SD	Swelling face	·	·	✓
SD	Urticaria	·	·	✓
SRO	Eye pain	·	·	✓
SRO	Musculoskeletal stiffness	✓	✓	✓

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