ZPZ-11510-79757

4 vaccinations 12 coded responses 22 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 085 / NJ
Registered: 2021-08-03

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

2021-07-06
Dose 1 — Moderna
2021-08-03
Registered in v-safe
2021-08-03
Dose 2 — Moderna
2021-08-03
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-08-04
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness · Be unable to work or attend school

Free text: lymph swelling

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-05
Survey response — days 1–6 daily, dose 2
MedDRA: Heart rate increased — Feeling: Good · Site: Pain, Swelling · Fever · Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Accelerated heart rate all 3 days

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-06
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Heart rate increased — Feeling: Good · Site: Pain · Fatigue or tiredness, Diarrhea

Free text: Cough, rapid heart beat

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Headache, Joint pains, Fatigue or tiredness, Diarrhea

Adult check-in
2021-08-08
Survey response — days 1–6 daily, dose 2
MedDRA: Palpitations — Feeling: Good · Joint pains, Fatigue or tiredness

Free text: Heart racing

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Fatigue or tiredness

Adult check-in
2021-08-12
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-08-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-08-24
Survey response — day 21, dose 2
MedDRA: Craniocerebral injury, Dehydration, Diarrhoea, Loss of consciousness — Feeling: Fair · Be unable to work or attend school

Free text: continued diarrhea resulting in dehydration resulting in passing out resulting in a traumatic brain injury. Not a good weekend.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-11-02
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2022-01-25
Dose 3 — Moderna
2022-02-01
Survey response — 6 months, dose 2
MedDRA: Body temperature increased, Fatigue, Oropharyngeal pain, Pain — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Had my third shot/first booster Jan 25th in my left thigh from Sante pharmacy (as per the Moderna orders) after cvs refused to use the alternate location. I had the same reaction; low temperature, fatigue, body aches, sore throat.

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Dose 4 — Moderna
2022-10-15
Survey response — days 1–6 daily, dose 4
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-10-16
Survey response — days 1–6 daily, dose 4
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain

Free text: Sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-10-17
Survey response — days 1–6 daily, dose 4
MedDRA: Upper-airway cough syndrome — Feeling: Good

Free text: Post Nasal drip

MedDRA releases: 2024-11 · check-in free text available
2022-10-18
Survey response — days 1–6 daily, dose 4
MedDRA: Aphonia, Dysphonia, Throat irritation — Feeling: Good

Free text: Scratchy throat; periodic voice break:loss

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Survey response — days 1–6 daily, dose 4
MedDRA: Oropharyngeal pain — Feeling: Good

Free text: Sore Throat

MedDRA releases: 2024-11 · check-in free text available
2022-11-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-11-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2023-04-13
Survey response — 6 months, dose 4
MedDRA: COVID-19 — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-13
Report sent to call center — 6 months, 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-14
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-06	Moderna	No
2	2021-08-03	Moderna	No
3	2022-01-25	Moderna	No
4	2022-10-13	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2023-04-13	Unsuccessful

Free text

Release 9 — days 1–6 daily, dose 2

2021-08-04

Systemic reaction (other): lymph swelling

2021-08-05

Systemic reaction (other): Accelerated heart rate all 3 days

2021-08-06

Systemic reaction (other): Cough, rapid heart beat

2021-08-08

Systemic reaction (other): Heart racing

Release 9 — day 21, dose 2

2021-08-24

Symptoms: continued diarrhea resulting in dehydration resulting in passing out resulting in a traumatic brain injury. Not a good weekend.

Release 11 — 6 months, dose 2

2022-02-01

Symptoms: Had my third shot/first booster Jan 25th in my left thigh from Sante pharmacy (as per the Moderna orders) after cvs refused to use the alternate location. I had the same reaction; low temperature, fatigue, body aches, sore throat.

Release 12 — days 1–6 daily, dose 4

2022-10-15

Systemic reaction (other): Sore throat

2022-10-16

Systemic reaction (other): Sore throat

2022-10-17

Systemic reaction (other): Post Nasal drip

2022-10-18

Systemic reaction (other): Scratchy throat; periodic voice break:loss

2022-10-19

Systemic reaction (other): Sore Throat

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
SD	Body temperature increased	·	·	✓
SD	COVID-19	·	·	✓
SD	Craniocerebral injury	✓	·	✓
SD	Dehydration	✓	·	✓
SD	Diarrhoea	✓	·	✓
SD	Fatigue	·	·	✓
SD	Loss of consciousness	✓	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SRO	Aphonia	·	·	✓
SRO	Cough	✓	·	✓
SRO	Dysphonia	·	·	✓
SRO	Heart rate increased	✓	·	✓
SRO	Lymphadenopathy	✓	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Palpitations	✓	·	✓
SRO	Throat irritation	·	·	✓
SRO	Upper-airway cough syndrome	·	·	✓

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