ZQ8-23791-42849

2 vaccinations 6 coded responses 8 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 913 / CA
Registered: 2021-02-25

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

2021-01-20
Dose 1 — Moderna
2021-02-17
Dose 2 — Moderna
2021-02-25
Registered in v-safe
2021-02-25
Survey response — day 7, dose 2
MedDRA: Herpes zoster — Feeling: Good · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: The second vaccination triggered shingles outbreak on left side of my lower back (I got the vaccine on my left arm).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-10
Survey response — day 21, dose 2
MedDRA: Fatigue, Headache, Herpes zoster — Feeling: Poor

Free text: Headache and fatigue. Shingles.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-24
Survey response — day 35, dose 2
MedDRA: Arthralgia, Herpes zoster, Nerve compression, Neuralgic amyotrophy, Sleep disorder, Specialist consultation — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Shingles from the vaccine/ post herpetic complications. Sudden severe shoulder pain and stabbing pain in left shoulder w/deep breath. Cant sleep supine. Possible phrenic nerve irritation. Possible Parsonage Turner Syndrome caused by the vaccine. · Healthcare visit (other): Rheumatologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-31
Survey response — day 42, dose 2
MedDRA: Neuralgic amyotrophy, Unevaluable event — Feeling: Poor · Be unable to work, 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: (b)(6) Why even ask these questions? This questionnaire is useless you do zero follow up . I am a public health nurse, but will no longer recommend Covid 19 vaccine for my family and friends. I will also be suing Moderna. · Healthcare visit (other): Multiple Specialists

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-19
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Back pain, Dermal filler reaction, Orthopnoea — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Now Im having SEVERE INFLAMMATION IN MY FACE WHERE I HAVE DERMAL FILLERS AND I AM EXTREMELY UPSET. My face looks DISFIGURED IN ADDITION TO THE SHOULDER AND BACK PAIN and new onset orthopnea since vaccine. (Suspected (b)(6)).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-19
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Survey response — 6 months, dose 2
MedDRA: Therapeutic product effect decreased — Feeling: Poor

Free text: Resistance to Botox and fillers since my vaccines

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-01-19
Call 1 — Left Voicemail
2022-01-21
Call successful
Reported to VAERS voluntarily prior to GDIT contact

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-20	Moderna
2	2021-02-17	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-03-24	Unsuccessful
2021-03-31	Unsuccessful
2021-05-19	Successful 2022-01-21	Reported to VAERS voluntarily prior to GDIT contact

Free text

Release 4 — day 7, dose 2

2021-02-25

Systemic reaction (other): The second vaccination triggered shingles outbreak on left side of my lower back (I got the vaccine on my left arm).

Release 5 — day 21, dose 2

2021-03-10

Symptoms: Headache and fatigue. Shingles.

Release 6 — day 35, dose 2

2021-03-24

Symptoms: Shingles from the vaccine/ post herpetic complications. Sudden severe shoulder pain and stabbing pain in left shoulder w/deep breath. Cant sleep supine. Possible phrenic nerve irritation. Possible Parsonage Turner Syndrome caused by the vaccine.

Healthcare visit (other): Rheumatologist

Release 6 — day 42, dose 2

2021-03-31

Symptoms: (b)(6) Why even ask these questions? This questionnaire is useless you do zero follow up . I am a public health nurse, but will no longer recommend Covid 19 vaccine for my family and friends. I will also be suing Moderna.

Healthcare visit (other): Multiple Specialists

redacted (b)(6)

Release 8 — 3 months, dose 2

2021-05-19

Symptoms: Now Im having SEVERE INFLAMMATION IN MY FACE WHERE I HAVE DERMAL FILLERS AND I AM EXTREMELY UPSET. My face looks DISFIGURED IN ADDITION TO THE SHOULDER AND BACK PAIN and new onset orthopnea since vaccine. (Suspected (b)(6)).

redacted (b)(6)

Release 9 — 6 months, dose 2

2021-08-18

Symptoms: Resistance to Botox and fillers since my vaccines

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	Specialist consultation	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Dermal filler reaction	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Herpes zoster	✓	✓	✓
SD	Nerve compression	✓	✓	✓
SD	Neuralgic amyotrophy	✓	✓	✓
SD	Orthopnoea	✓	✓	✓
SD	Sleep disorder	✓	✓	✓
SD	Therapeutic product effect decreased	✓	·	✓
SRO	Herpes zoster	✓	✓	✓

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