ZPY-36666-12985

3 vaccinations 9 coded responses 34 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 074 / NJ
Registered: 2021-01-18

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

2021-01-13
Dose 1 — Moderna
2021-01-18
Registered in v-safe
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain, Injection site pruritus, Injection site warmth, Rash macular — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness

Free text: A red blotchy patch a few inches below the injection site that was warm to touch sore and a little itchy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Erythema, Rash macular — Feeling: Good · Site: Pain, Redness · Headache, Fatigue or tiredness

Free text: Red blotchy area has faded and is mild now

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · Site: Pain, Redness · Fatigue or tiredness

Adult check-in
2021-01-27
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site pruritus, Injection site swelling — Feeling: Fair

Free text: The red area at the injection site came back and was swollen and had a lump under the skin. It was also itchy. It is starting to feel a little better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-10
Dose 2 — Moderna
2021-02-10
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Headache

Adult check-in
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tiredness, Nausea

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Headache, 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
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-02-17
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-24
Survey response — day 14, dose 2
MedDRA: Dizziness, Fatigue — Feeling: Fair

Free text: Dizziness, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-26
Survey response — day 42, dose 2
MedDRA: Office visit, Oral disorder, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Tongue sore/lesion but I have a hx of oral cancer as well. · Healthcare visit (other): In person dr appt

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-12
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-11
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2021-11-16
Dose 3 — Moderna
2021-11-17
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness, Nausea

Adult check-in
2021-11-18
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Adult check-in
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · None

Adult check-in
2021-11-23
Health check-in — day 7, dose 3
Feeling: Fair · Nausea

Adult check-in
2021-12-02
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-07
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-12-14
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-21
Survey response — day 35, dose 3
MedDRA: Dizziness, Headache — Feeling: Fair

Free text: Headaches and dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Survey response — day 42, dose 3
MedDRA: COVID-19 — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: COVID 19

MedDRA releases: 2024-11 · check-in free text available
2022-01-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-15
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-17
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-16
Survey response — 12 months, dose 3
MedDRA: Leukoplakia, Pre-existing disease, Surgery — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Recurrence of leukoplakia requiring surgery due to being an (oral cancer survivor) two occurrences in one year. Prior dates were many years apart.

MedDRA releases: 2024-11 · check-in free text available
2022-11-16
Report sent to call center — 12 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-17
Call 1 — Left Voicemail
2022-11-17
Callback requested for
05:00PM ET
2022-11-17
Call successful
Participant prefers to complete VAERS report online

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-13	Moderna
2	2021-02-10	Moderna
3	2021-11-16	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-26	Successful 2022-01-14	Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-11-16	Successful 2022-11-17	Participant prefers to complete VAERS report online

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-18

Systemic reaction (other): A red blotchy patch a few inches below the injection site that was warm to touch sore and a little itchy

2021-01-19

Systemic reaction (other): Red blotchy area has faded and is mild now

Release 2 — day 14, dose 1

2021-01-27

Symptoms: The red area at the injection site came back and was swollen and had a lump under the skin. It was also itchy. It is starting to feel a little better today.

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): Dizziness

Release 4 — day 14, dose 2

2021-02-24

Symptoms: Dizziness, fatigue

Release 6 — day 42, dose 2

2021-03-26

Symptoms: Tongue sore/lesion but I have a hx of oral cancer as well.

Healthcare visit (other): In person dr appt

Release 10 — day 35, dose 3

2021-12-21

Symptoms: Headaches and dizziness

Release 10 — day 42, dose 3

2021-12-28

Symptoms: COVID 19

Release 12 — 12 months, dose 3

2022-11-16

Symptoms: Recurrence of leukoplakia requiring surgery due to being an (oral cancer survivor) two occurrences in one year. Prior dates were many years apart.

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	COVID-19	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Leukoplakia	·	·	✓
SD	Oral disorder	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Surgery	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Injection site warmth	✓	✓	✓
SRO	Rash macular	✓	✓	✓

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