ZRL-26004-38498

5 vaccinations 10 coded responses 40 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 828 / WY
Registered: 2021-01-08

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

2021-01-06
Dose 1 — Moderna
2021-01-08
Registered in v-safe
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Dose 2 — Moderna
2021-02-01
Health check-in — day 0, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Chills, Fatigue or tiredness

Adult check-in
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Good · Site: Itching

Free text: Iy made my smallpox vaccination area itch. The area is near this vaccination.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-15
Survey response — day 14, dose 2
MedDRA: Abdominal distension, Abdominal pain upper, Constipation — Feeling: Fair · Be unable to do your normal daily activities

Free text: The onions in a homemade meatloaf made me very sick. I am somewhat allergic, but I was surprised. Bloating, gut-ache, constipation.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-08
Survey response — day 35, dose 2
MedDRA: Back pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: lower back pain after moving heavy boxes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — day 42, dose 2
MedDRA: Back pain — Feeling: Good · Be unable to do your normal daily activities

Free text: Very sore back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Survey response — 3 months, dose 2
MedDRA: Medical counselling, Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: UTI · Healthcare visit (other): Womens health center in (b)(6).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-30
Dose 3 — Moderna
2021-09-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · Muscle or body aches

Adult check-in
2021-09-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-09-06
Health check-in — day 7, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-13
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-09-20
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-09-27
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-10-04
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-10-11
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2021-11-29
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-15
Call 1 — Left Voicemail
2022-04-15
Call successful
Does not wish to fill out VAERS report
2022-04-23
Dose 4 — Moderna
2022-05-15
Survey response — day 21, dose 4
MedDRA: Cough, Exposure to SARS-CoV-2, Nasopharyngitis, Oropharyngeal pain, Productive cough, SARS-CoV-2 test negative — Feeling: Poor · Be unable to do your normal daily activities

Free text: Head cold, sore throat, phlegm, bad cough. I have done 2 antigen tests and3tests at (b)(6) testing center. All covid tests were negative. My daughter inlaw's parents came by our house not knowing they hadCovid.

MedDRA releases: 2024-11 · check-in free text available
2022-05-22
Survey response — day 28, dose 4
MedDRA: Aphonia, Cough, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

Free text: Testing negative but have a bad cough, lost my voice for a while and head congestion.

MedDRA releases: 2024-11 · check-in free text available
2022-05-30
Survey response — day 35, dose 4
MedDRA: Bronchitis, Cough, SARS-CoV-2 test negative — Feeling: Poor · Be unable to do your normal daily activities

Free text: Cough, bronchitis Negative for covid

MedDRA releases: 2024-11 · check-in free text available
2022-06-04
Survey response — day 42, dose 4
MedDRA: Cough — Feeling: Poor · Be unable to do your normal daily activities

Free text: Coughing

MedDRA releases: 2024-11 · check-in free text available
2022-07-23
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-19
Dose 5 — Moderna
2022-10-11
Survey response — day 21, dose 5
MedDRA: Arthritis — Feeling: Good · Be unable to do your normal daily activities

Free text: My arthritis is getting worse.

MedDRA releases: 2024-11 · check-in free text available
2022-10-17
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-24
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-10-31
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-19
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-20
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-06	Moderna
2	2021-02-01	Moderna
3	2021-08-30	Moderna	No
4	2022-04-23	Moderna	No
5	2022-09-19	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-05-03	Successful 2022-04-15	Does not wish to fill out VAERS report

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-07

Systemic reaction (other): Iy made my smallpox vaccination area itch. The area is near this vaccination.

Release 4 — day 14, dose 2

2021-02-15

Symptoms: The onions in a homemade meatloaf made me very sick. I am somewhat allergic, but I was surprised. Bloating, gut-ache, constipation.

Release 5 — day 35, dose 2

2021-03-08

Symptoms: lower back pain after moving heavy boxes

Release 5 — day 42, dose 2

2021-03-15

Symptoms: Very sore back

Release 8 — 3 months, dose 2

2021-05-03

Symptoms: UTI

Healthcare visit (other): Womens health center in (b)(6).

redacted (b)(6)

Release 11 — day 21, dose 4

2022-05-15

Symptoms: Head cold, sore throat, phlegm, bad cough. I have done 2 antigen tests and3tests at (b)(6) testing center. All covid tests were negative. My daughter inlaw's parents came by our house not knowing they hadCovid.

redacted (b)(6)

Release 11 — day 28, dose 4

2022-05-22

Symptoms: Testing negative but have a bad cough, lost my voice for a while and head congestion.

Release 11 — day 35, dose 4

2022-05-30

Symptoms: Cough, bronchitis Negative for covid

Release 11 — day 42, dose 4

2022-06-04

Symptoms: Coughing

Release 12 — day 21, dose 5

2022-10-11

Symptoms: My arthritis is getting worse.

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	✓	✓	✓
SD	Abdominal distension	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Aphonia	·	·	✓
SD	Arthritis	·	·	✓
SD	Back pain	✓	✓	✓
SD	Bronchitis	·	·	✓
SD	Constipation	✓	✓	✓
SD	Cough	·	·	✓
SD	Exposure to SARS-CoV-2	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Productive cough	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Urinary tract infection	✓	✓	✓
SRO	Pruritus	✓	✓	✓

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