ZRV-21534-49061

4 vaccinations 12 coded responses 42 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 119 / NY
Registered: 2021-02-11

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

2021-02-11
Registered in v-safe
2021-02-11
Dose 1 — Moderna
2021-02-11
Health check-in — day 0, dose 1
Feeling: Good · Site: Swelling · Chills, Fatigue or tiredness, Nausea

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

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

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Nausea

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Nausea, Diarrhea

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Nausea, Diarrhea

Adult check-in
2021-02-25
Survey response — day 14, dose 1
MedDRA: Fatigue, Headache, Nausea — Feeling: Fair

Free text: Nausea, headaches, fatigue

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

Adult check-in
2021-03-11
Dose 2 — Moderna
2021-03-25
Survey response — day 14, dose 2
MedDRA: Influenza like illness — Feeling: Good · Be unable to do your normal daily activities

Free text: Flu like reaction to 2nd dose for 24 hours

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-15
Survey response — day 35, dose 2
MedDRA: Rash, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Mystery rash on left breast (same side as shot in left arm) had it for about 10 days?? · Healthcare visit (other): Mammogram

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-22
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-10
Survey response — 3 months, dose 2
MedDRA: Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Rash on my left breast (same side as vax) dr thinks it could be reaction to breast implants from vaccine · Healthcare visit (other): My primary care physician and gynecologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-21
Call 1 — Left Voicemail
2021-09-09
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-25
Dose 3 — Moderna
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-11-03
Health check-in — day 7, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Survey response — day 21, dose 3
MedDRA: Dizziness, Heart rate decreased — Feeling: Fair

Free text: Low heart rate dizziness

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Survey response — day 28, dose 3
MedDRA: Lymphadenopathy — Feeling: Good

Free text: Swollen lymph glands underarms

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Survey response — day 35, dose 3
MedDRA: Injection site rash — Feeling: Good

Free text: Light rash on the arm injection site

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Survey response — day 42, dose 3
MedDRA: Injection site rash, Lymphadenopathy, Rash pruritic — Feeling: Good

Free text: Itchy rash on injection site, swollen underarm lymph glands

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-01
Dose 4 — Moderna
2022-04-01
Health check-in — day 0, dose 4
Feeling: Good · Site: Swelling · None

Adult check-in
2022-04-02
Health check-in — days 1–6 daily, dose 4
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2022-04-03
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-04
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-05
Survey response — days 1–6 daily, dose 4
MedDRA: Injection site reaction, Rash erythematous — Feeling: Fair · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Free text: Bumpy red rash has appeared around injection site

MedDRA releases: 2024-11 · check-in free text available
2022-04-06
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-07
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Itching · Headache

Adult check-in
2022-04-08
Health check-in — day 7, dose 4
Feeling: Good · Site: Pain, Swelling, Itching · Headache

Adult check-in
2022-04-15
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-22
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-29
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-13
Survey response — day 42, dose 4
MedDRA: Arthropod bite, Lyme disease, Office visit — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Tick bite lyme disease · Healthcare visit (other): Primary care physician

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-16
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-01
Survey response — 3 months, dose 4
MedDRA: Injection site rash — Feeling: Good

Free text: Ongoing rash on right arm around injection site

MedDRA releases: 2024-11 · check-in free text available
2022-10-02
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-01
Survey response — 12 months, dose 4
MedDRA: Bradycardia, Cardiac pacemaker insertion — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-04-01
Report sent to call center — 12 months, dose 4
Be unable to work or attend school · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-04-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-11	Moderna
2	2021-03-11	Moderna
3	2021-10-25	Moderna	No
4	2022-04-01	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-04-15	Successful 2022-05-16	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-06-10	Successful 2022-05-16	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-13	Successful 2022-05-16	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-01	Unsuccessful

Free text

Release 4 — day 14, dose 1

2021-02-25

Symptoms: Nausea, headaches, fatigue

Release 6 — day 14, dose 2

2021-03-25

Symptoms: Flu like reaction to 2nd dose for 24 hours

Release 7 — day 35, dose 2

2021-04-15

Symptoms: Mystery rash on left breast (same side as shot in left arm) had it for about 10 days??

Healthcare visit (other): Mammogram

Release 9 — 3 months, dose 2

2021-06-10

Symptoms: Rash on my left breast (same side as vax) dr thinks it could be reaction to breast implants from vaccine

Healthcare visit (other): My primary care physician and gynecologist

Release 10 — day 21, dose 3

2021-11-15

Symptoms: Low heart rate dizziness

Release 10 — day 28, dose 3

2021-11-22

Symptoms: Swollen lymph glands underarms

Release 10 — day 35, dose 3

2021-11-29

Symptoms: Light rash on the arm injection site

Release 10 — day 42, dose 3

2021-12-06

Symptoms: Itchy rash on injection site, swollen underarm lymph glands

Release 11 — days 1–6 daily, dose 4

2022-04-05

Systemic reaction (other): Bumpy red rash has appeared around injection site

Release 11 — day 42, dose 4

2022-05-13

Symptoms: Tick bite lyme disease

Healthcare visit (other): Primary care physician

Release 12 — 3 months, dose 4

2022-07-01

Symptoms: Ongoing rash on right arm around injection site

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	Unevaluable event	✓	✓	✓
SD	Arthropod bite	·	·	✓
SD	Bradycardia	·	·	✓
SD	Cardiac pacemaker insertion	·	·	✓
SD	Dizziness	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate decreased	·	·	✓
SD	Influenza like illness	✓	✓	✓
SD	Injection site rash	·	·	✓
SD	Lyme disease	·	·	✓
SD	Lymphadenopathy	·	·	✓
SD	Nausea	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	·	·	✓
SRO	Injection site rash	·	·	○
SRO	Injection site reaction	·	·	✓
SRO	Rash erythematous	·	·	✓

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