ZNS-19503-00697

3 vaccinations 9 coded responses 31 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 731 / OK
Registered: 2021-03-27

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

2021-02-27
Dose 1 — Moderna
2021-03-27
Registered in v-safe
2021-03-27
Dose 2 — Moderna
2021-03-27
Survey response — day 0, dose 2
MedDRA: Hypoaesthesia, Limb discomfort — Feeling: Good · Site: Pain, Redness

Free text: Arm feels heavy, numbness in 4th and 5th fingers

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Good

Free text: Im worried that the day I had all these symptoms i could not report them. The link said it was too late to report for that day.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Health check-in — day 7, dose 2
Feeling: Good · Headache

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

Adult check-in
2021-04-17
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-01
Survey response — day 35, dose 2
MedDRA: Headache — Feeling: Good

Free text: Persistent headache...for 3 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-26
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-27
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-05
Dose 3 — Moderna
2022-04-05
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2022-04-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2022-04-07
Survey response — days 1–6 daily, dose 3
MedDRA: Rhinorrhoea — Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Free text: Runny nose

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Survey response — days 1–6 daily, dose 3
MedDRA: Rhinorrhoea — Feeling: Good · Site: Pain, Swelling

Free text: Sniffles

MedDRA releases: 2024-11 · check-in free text available
2022-04-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · Fatigue or tiredness

Adult check-in
2022-04-10
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue — Feeling: Good · Headache

Free text: Tiredness

MedDRA releases: 2024-11 · check-in free text available
2022-04-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-04-12
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-04-19
Survey response — day 14, dose 3
MedDRA: Nasopharyngitis, Sinus disorder — Feeling: Good

Free text: Have sinus trouble, like a mild cold

MedDRA releases: 2024-11 · check-in free text available
2022-04-26
Survey response — day 21, dose 3
MedDRA: Nasopharyngitis, Oropharyngeal pain, Sinus congestion — Feeling: Fair

Free text: Cold symptoms, sinus congestion and sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-05-10
Survey response — day 35, dose 3
MedDRA: Hypoaesthesia, Monoplegia, Nerve injury, Office visit, Post procedural complication, Spinal operation, Sudden visual loss, Unevaluable event, Visual impairment — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Ive had back surgery, everything is worse. I have some kind of damage or paralysis in right leg. Numbness or nerve damage in the left thigh, and right hand. At Doctors now to get diagnosis for sudden disruption in visual field of right eye. · Healthcare visit (other): Still determining if ER visit is necessary.

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Report sent to call center — day 35, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-07-05
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-10-04
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-04-05
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-27	Moderna
2	2021-03-27	Moderna
3	2022-04-05	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-05-10	Successful 2022-05-11	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Free text

Release 6 — day 0, dose 2

2021-03-27

Systemic reaction (other): Arm feels heavy, numbness in 4th and 5th fingers

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): Im worried that the day I had all these symptoms i could not report them. The link said it was too late to report for that day.

Release 8 — day 35, dose 2

2021-05-01

Symptoms: Persistent headache...for 3 days

Release 11 — days 1–6 daily, dose 3

2022-04-07

Systemic reaction (other): Runny nose

2022-04-08

Systemic reaction (other): Sniffles

2022-04-10

Systemic reaction (other): Tiredness

Release 11 — day 14, dose 3

2022-04-19

Symptoms: Have sinus trouble, like a mild cold

Release 11 — day 21, dose 3

2022-04-26

Symptoms: Cold symptoms, sinus congestion and sore throat

Release 11 — day 35, dose 3

2022-05-10

Symptoms: Ive had back surgery, everything is worse. I have some kind of damage or paralysis in right leg. Numbness or nerve damage in the left thigh, and right hand. At Doctors now to get diagnosis for sudden disruption in visual field of right eye.

Healthcare visit (other): Still determining if ER visit is necessary.

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	Headache	✓	✓	✓
SD	Hypoaesthesia	·	·	✓
SD	Monoplegia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nerve injury	·	·	✓
SD	Office visit	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Post procedural complication	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sinus disorder	·	·	✓
SD	Spinal operation	·	·	✓
SD	Sudden visual loss	·	·	✓
SD	Visual impairment	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Fatigue	·	·	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Limb discomfort	✓	✓	✓
SRO	Rhinorrhoea	·	·	✓

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