ZP7-21590-57556

1 vaccination 7 coded responses 12 check-ins 7 free-text entries 6 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 995 / AK
Registered: 2021-01-12

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

2021-01-12
Registered in v-safe
2021-01-12
Dose 1 — Moderna
2021-01-12
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-12
Report sent to call center — day 0, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal pain upper, Chest pain, Unevaluable event — Feeling: Fair · Site: Pain · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): 1/12/2021 Moderna vaccine about 1hr and 1/2 after shot had bad chest upper stomach pain unusual pain never felt before. Might have been a rapid heart response. Lasted like a few minutes but subsided ,went away. I am very concerned! · Healthcare visit (other): Trying to find a doctor or tell health now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-14
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Headache, Migraine, Telemedicine — Feeling: Fair · Site: Pain · Headache · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Jan12,2021 @3:45pm unusual pain in chest 1 hour 15 minutes after Moderna (b)(6) , it lasted a few minutes, then no more. One time event only after vaccine. I do not have any history of heart issues. But was significant!.today just a migraine headache temple eye/ear area . · Healthcare visit (other): Virtual health (b)(6)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Chest pain, Telemedicine — Feeling: Good · Site: Pain · Headache · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Went to doctor about Chest pain 1hr after Moderna shot he suggested getting heart checked out so I am making appointment. · Healthcare visit (other): Virtual visit (b)(6) express care referral to primary care doctor making appointment.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Angina pectoris, Unevaluable event — Feeling: Fair · Site: Pain · Muscle or body aches · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): The heart pain on1/12/2021 need doctor to check heart · Healthcare visit (other): Waiting for doctor appointment

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · None

Adult check-in
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Muscle or body aches

Free text: Mild pain arm of shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — day 7, dose 1
MedDRA: Chest pain — Feeling: Fair

Free text: Waiting for doc appointment for 1st day chest pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Health check-in — day 14, dose 1
Feeling: Fair

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

Adult check-in
2021-02-25
Health check-in — day 42, dose 1
Feeling: Good

Adult check-in
2021-03-02
Call 1 — Left Voicemail
2021-07-15
Survey response — 6 months, dose 1
MedDRA: Office visit, Pain, Skin discolouration — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Still have a dark skin coloration on both sides of stomach. Stings on a regular basis. Only had 1st Moderna shot Jan 2021. Getting 2nd shot this wee or next. · Healthcare visit (other): Went to a general doc back in March ,she did not know what it was.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-15
Report sent to call center — 6 months, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-20
Call 1 — Left Voicemail
2021-07-21
Call 2 — Left Voicemail
2021-10-06
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-12	Unsuccessful	Reported to VAERS voluntarily prior to GDIT contact
2021-01-13	Unsuccessful	Reported to VAERS voluntarily prior to GDIT contact
2021-01-14	Unsuccessful	Reported to VAERS voluntarily prior to GDIT contact
2021-01-15	Unsuccessful	Reported to VAERS voluntarily prior to GDIT contact
2021-01-16	Unsuccessful	Reported to VAERS voluntarily prior to GDIT contact
2021-07-15	Successful 2021-10-06	Participant prefers to complete VAERS report online

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-13

Systemic reaction (other): 1/12/2021 Moderna vaccine about 1hr and 1/2 after shot had bad chest upper stomach pain unusual pain never felt before. Might have been a rapid heart response. Lasted like a few minutes but subsided ,went away. I am very concerned!

Healthcare visit (other): Trying to find a doctor or tell health now.

Release 2 — days 1–6 daily, dose 1

2021-01-14

Systemic reaction (other): Jan12,2021 @3:45pm unusual pain in chest 1 hour 15 minutes after Moderna (b)(6) , it lasted a few minutes, then no more. One time event only after vaccine. I do not have any history of heart issues. But was significant!.today just a migraine headache temple eye/ear area .

Healthcare visit (other): Virtual health (b)(6)

redacted (b)(6)

2021-01-15

Systemic reaction (other): Went to doctor about Chest pain 1hr after Moderna shot he suggested getting heart checked out so I am making appointment.

Healthcare visit (other): Virtual visit (b)(6) express care referral to primary care doctor making appointment.

redacted (b)(6)

2021-01-16

Systemic reaction (other): The heart pain on1/12/2021 need doctor to check heart

Healthcare visit (other): Waiting for doctor appointment

2021-01-18

Systemic reaction (other): Mild pain arm of shot

Release 2 — day 7, dose 1

2021-01-21

Systemic reaction (other): Waiting for doc appointment for 1st day chest pain

Release 9 — 6 months, dose 1

2021-07-15

Symptoms: Still have a dark skin coloration on both sides of stomach. Stings on a regular basis. Only had 1st Moderna shot Jan 2021. Getting 2nd shot this wee or next.

Healthcare visit (other): Went to a general doc back in March ,she did not know what it was.

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	Telemedicine	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Pain	✓	·	✓
SD	Skin discolouration	✓	·	✓
SRO	Abdominal pain upper	✓	✓	✓
SRO	Angina pectoris	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Migraine	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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