ZMY-63267-53171

3 vaccinations 10 coded responses 26 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 605 / IL
Registered: 2021-02-17

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

2021-02-13
Dose 1 — Moderna
2021-02-17
Registered in v-safe
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Loss of appetite!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite, Pain in extremity, Sleep disorder — Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Loss of appetite! Not sleeping arm pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-20
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-27
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-06
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-13
Dose 2 — Moderna
2021-03-20
Survey response — day 7, dose 2
MedDRA: Lip swelling, Swelling face — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Facial & lip swelling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Survey response — day 14, dose 2
MedDRA: Abdominal pain upper, Fatigue, Migraine, Nausea — Feeling: Poor · Be unable to do your normal daily activities

Free text: Stomach pain, nausea, still migraine, exhaustion!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — day 21, dose 2
MedDRA: Arthralgia, Chills, Pain in extremity, Pyrexia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Fever chill, shoulders to elbows extremely sore both arms!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — day 28, dose 2
MedDRA: Arthralgia, Fatigue, Headache, Office visit, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: More severe headaches, extreme fatigue,Sharp pains in feet, ankles, knees, shoulder & elbows! Its been since 1st shot 2/13 & I have not had one good day-but able to see grandkids!!!! · Healthcare visit (other): Dr office visit

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Report sent to call center — day 28, 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
Health check-in — day 35, dose 2
Feeling: Poor

Adult check-in
2021-04-25
Survey response — day 42, dose 2
MedDRA: Fatigue, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Bottom of both feet sore not gout or arthritis, still extremely fatigued!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-11
Survey response — 6 months, dose 2
MedDRA: Rash, Rash macular — Feeling: Fair

Free text: Rash on both legs- spreading for last 3 weeks! Trying to get an apt with dermatologist!!! Not itchy - just blotchy! My Dr only sees healthy patients!

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Dose 3 — Moderna
2021-10-28
Health check-in — day 0, dose 3
Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work or attend school

Adult check-in
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Balance disorder, Dizziness — Feeling: Poor · Chills, Headache, Fatigue or tiredness · Be unable to work or attend school

Free text: Dizziness, off balance

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-04
Health check-in — day 7, dose 3
Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to work or attend school, Be unable to do your normal daily activities

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

Adult check-in
2021-11-19
Health check-in — day 21, dose 3
Feeling: Poor

Adult check-in
2021-11-26
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-04
Survey response — day 35, dose 3
MedDRA: Fatigue, Mobility decreased — Feeling: Poor · Be unable to do your normal daily activities

Free text: Fatigue - can barely get out of bed least little chore leaves me exhausted! Is this going to be permanent? Taking vitamins, Plenty of liquids, eating properly! Just really tired

MedDRA releases: 2024-11 · check-in free text available
2021-12-09
Health check-in — day 42, dose 3
Feeling: Poor

Adult check-in
2022-01-29
Health check-in — 3 months, dose 3
Feeling: Poor

Adult check-in
2022-03-25
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-13	Moderna
2	2021-03-13	Moderna
3	2021-10-28	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-10	Unsuccessful

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-17

Systemic reaction (other): Loss of appetite!

2021-02-18

Systemic reaction (other): Loss of appetite! Not sleeping arm pain

Release 6 — day 7, dose 2

2021-03-20

Systemic reaction (other): Facial & lip swelling

Release 6 — day 14, dose 2

2021-03-27

Symptoms: Stomach pain, nausea, still migraine, exhaustion!

Release 6 — day 21, dose 2

2021-04-03

Symptoms: Fever chill, shoulders to elbows extremely sore both arms!

Release 7 — day 28, dose 2

2021-04-10

Symptoms: More severe headaches, extreme fatigue,Sharp pains in feet, ankles, knees, shoulder & elbows! Its been since 1st shot 2/13 & I have not had one good day-but able to see grandkids!!!!

Healthcare visit (other): Dr office visit

Release 7 — day 42, dose 2

2021-04-25

Symptoms: Bottom of both feet sore not gout or arthritis, still extremely fatigued!

Release 9 — 6 months, dose 2

2021-09-11

Symptoms: Rash on both legs- spreading for last 3 weeks! Trying to get an apt with dermatologist!!! Not itchy - just blotchy! My Dr only sees healthy patients!

Release 10 — days 1–6 daily, dose 3

2021-11-02

Systemic reaction (other): Dizziness, off balance

Release 10 — day 35, dose 3

2021-12-04

Symptoms: Fatigue - can barely get out of bed least little chore leaves me exhausted! Is this going to be permanent? Taking vitamins, Plenty of liquids, eating properly! Just really tired

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	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Migraine	✓	✓	✓
SD	Mobility decreased	·	·	✓
SD	Nausea	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	·	·	✓
SD	Rash macular	·	·	✓
SRO	Balance disorder	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dizziness	·	·	✓
SRO	Lip swelling	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓
SRO	Swelling face	✓	✓	✓

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