ZP5-28210-87141

5 vaccinations 8 coded responses 34 check-ins 8 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 331 / FL
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue, Pain — Feeling: Good · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness

Free text: But I usually am tired and achy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Survey response — day 14, dose 1
MedDRA: Abscess, Blood pressure increased, Body temperature increased, Constipation, Office visit, Pain, Swelling face — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Abbess of tooth. Temperature spike, pain, blood pressure spike, swollen face.Constipation · Healthcare visit (other): Dental clinic for tooth, Urgent care for high blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Report sent to call center — day 14, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Initial insomnia — Feeling: Good · Fatigue or tiredness

Free text: Difficulty going to sleep last 2 nights

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-12
Survey response — day 28, dose 2
MedDRA: Initial insomnia, Insomnia, Sleep disorder — Feeling: Good · Be unable to do your normal daily activities

Free text: Problems sleeping. Cant go to sleep, seeing clock til 2 am some nights. When asleep interrupted almost hourly. Tried warm herbal teas, soft lullaby music, dark room, etc. I dont know if this is related to vaccine or not. Happening about 1 month now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-09
Call 1 — Left Voicemail
2021-08-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-07
Dose 3 — Moderna
2022-02-12
Survey response — 12 months, dose 2
MedDRA: Limb injury, Office visit, Road traffic accident, Spinal column injury — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: My car was t-boned by another car. I have been reuperating from cervical, lumbar and leg injuries. · Healthcare visit (other): Private doctor and therapy healthcare in person.

MedDRA releases: 2024-11 · check-in free text available
2022-02-12
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2022-02-15
Call 1 — Left Voicemail
2022-03-10
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-23
Dose 4 — Moderna
2022-07-12
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-07-14
Survey response — day 21, dose 4
MedDRA: Body temperature increased, Cough, Headache, Nasal congestion, Rhinorrhoea — 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 · Telehealth, virtual health, or email health consultation

Free text: Yesterday I a driipy nose, then last night I had nasal congestion so bad I could not use my CPAP machine. This morning temperature spiked to 100.2, then down to 99.8 at noon. Coughing and headache added to symptoms. So I use one of the self Covid t

MedDRA releases: 2024-11 · check-in free text available
2022-07-14
Report sent to call center — day 21, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-21
Survey response — day 28, dose 4
MedDRA: Medical counselling, SARS-CoV-2 test positive — 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 · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Tested positive for Covid despite 4 shots of Moderna, last one on June 23, 2022. · Healthcare visit (other): Zoom, email and telephone

MedDRA releases: 2024-11 · check-in free text available
2022-07-21
Report sent to call center — day 28, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-22
Call 1 — Left Voicemail
2022-07-22
Call successful
Reported to VAERS voluntarily prior to GDIT contact
2022-07-28
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-08-05
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-09-24
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-12-23
Survey response — 6 months, dose 4
MedDRA: Balance disorder, Blood pressure increased, Dizziness, Fall, Headache, Office visit — Feeling: Fair · 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: Unexpected blood pressure pike twice. Dizziness, lite headache, unbslanced feeling. Fell on floor once. · Healthcare visit (other): UHealth Clinic and Urgent care.

MedDRA releases: 2024-11 · check-in free text available
2022-12-23
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-27
Call successful
Completed over the phone
2023-02-23
Dose 5 — Moderna
2023-04-12
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-05-25
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-12	Moderna
3	2021-12-07	Moderna	No
4	2022-06-23	Moderna	No
5	2023-02-23	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-01-28	Successful 2022-07-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-12	Successful 2022-07-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-14	Successful 2022-07-15	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-21	Successful 2022-07-22	Reported to VAERS voluntarily prior to GDIT contact
2022-12-23	Successful 2022-12-27	Completed over the phone

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): But I usually am tired and achy.

Release 3 — day 14, dose 1

2021-01-28

Symptoms: Abbess of tooth. Temperature spike, pain, blood pressure spike, swollen face.Constipation

Healthcare visit (other): Dental clinic for tooth, Urgent care for high blood pressure

Release 4 — days 1–6 daily, dose 2

2021-02-16

Systemic reaction (other): Difficulty going to sleep last 2 nights

Release 5 — day 28, dose 2

2021-03-12

Symptoms: Problems sleeping. Cant go to sleep, seeing clock til 2 am some nights. When asleep interrupted almost hourly. Tried warm herbal teas, soft lullaby music, dark room, etc. I dont know if this is related to vaccine or not. Happening about 1 month now. cut off by CDC

Release 11 — 12 months, dose 2

2022-02-12

Symptoms: My car was t-boned by another car. I have been reuperating from cervical, lumbar and leg injuries.

Healthcare visit (other): Private doctor and therapy healthcare in person.

Release 12 — day 21, dose 4

2022-07-14

Symptoms: Yesterday I a driipy nose, then last night I had nasal congestion so bad I could not use my CPAP machine. This morning temperature spiked to 100.2, then down to 99.8 at noon. Coughing and headache added to symptoms. So I use one of the self Covid t cut off by CDC

Release 12 — day 28, dose 4

2022-07-21

Symptoms: Tested positive for Covid despite 4 shots of Moderna, last one on June 23, 2022.

Healthcare visit (other): Zoom, email and telephone

Release 12 — 6 months, dose 4

2022-12-23

Symptoms: Unexpected blood pressure pike twice. Dizziness, lite headache, unbslanced feeling. Fell on floor once.

Healthcare visit (other): UHealth Clinic and Urgent care.

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	Medical counselling	·	·	✓
HCVO	Office visit	✓	✓	✓
SD	Abscess	✓	✓	✓
SD	Balance disorder	·	·	✓
SD	Blood pressure increased	✓	✓	✓
SD	Body temperature increased	✓	✓	✓
SD	Constipation	✓	✓	✓
SD	Cough	·	·	✓
SD	Dizziness	·	·	✓
SD	Fall	·	·	✓
SD	Headache	·	·	✓
SD	Initial insomnia	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Limb injury	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Pain	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Road traffic accident	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sleep disorder	✓	✓	✓
SD	Spinal column injury	·	·	✓
SD	Swelling face	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Initial insomnia	✓	✓	✓
SRO	Pain	✓	✓	✓

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