ZS9-21612-38534

2 vaccinations 15 coded responses 25 check-ins 15 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 751 / TX
Registered: 2021-02-05

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

2021-02-05
Registered in v-safe
2021-02-05
Dose 1 — Moderna
2021-02-05
Survey response — day 0, dose 1
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Influenza like illness, Lacrimation increased, Nasopharyngitis, Rhinorrhoea, Sneezing — Feeling: Fair · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Cold or flu s/s: sneezing, rhinnorhea, watery eyes,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 1
MedDRA: Lip blister, Urticaria — Feeling: Fair · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Hives with blister top

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 1
MedDRA: Rash, Urticaria — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Rash with hives (minimal number)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — day 7, dose 1
MedDRA: Lacrimation increased, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea, Sneezing — Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Cold symptoms persist: sore throat, rhinnorrhea, sneezing, watery eyes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — day 14, dose 1
MedDRA: Rash — Feeling: Good

Free text: Rash on leg still present but showing up on R thigh

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Survey response — day 0, dose 2
MedDRA: Pruritus — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Itching of lower extremities!!!!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Irritability, Peripheral swelling, Pruritus, Rash macular, Urticaria — Feeling: Fair · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection site

Free text: Swelling of lower extremities, rash of macular style, skin very reddened with occasional hive. The itching is so irritating. Legs look water logged.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-09
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Better today! No itching, leg swelling!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Good · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: No...fatigue is worse.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 7, dose 2
MedDRA: Fatigue, Pruritus — Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Itching, fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 21, dose 2
Feeling: Fair

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

Adult check-in
2021-04-09
Survey response — day 35, dose 2
MedDRA: Arrhythmia, Headache, Hypoaesthesia, Oedema peripheral, Office visit, Pain in extremity, Rash, Weight increased — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Increased edema in lower extremities. Rash increased all over lower extremities, weight gain keeps occurring, dysrhythmias occurs at night, bad headaches. Numbness in left hand and increased pain in left arm. · Healthcare visit (other): Drs office

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

1 call case(s)
2021-04-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-21
Call 1 — Left Voicemail
2022-03-05
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-04-09	Unsuccessful

Free text

Release 3 — day 0, dose 1

2021-02-05

Systemic reaction (other): No

Release 3 — days 1–6 daily, dose 1

2021-02-07

Systemic reaction (other): No

2021-02-09

Systemic reaction (other): Cold or flu s/s: sneezing, rhinnorhea, watery eyes,

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Hives with blister top

2021-02-11

Systemic reaction (other): Rash with hives (minimal number)

Release 4 — day 7, dose 1

2021-02-12

Systemic reaction (other): Cold symptoms persist: sore throat, rhinnorrhea, sneezing, watery eyes.

Release 4 — day 14, dose 1

2021-02-19

Symptoms: Rash on leg still present but showing up on R thigh

Release 5 — day 0, dose 2

2021-03-05

Systemic reaction (other): Itching

Release 5 — days 1–6 daily, dose 2

2021-03-07

Systemic reaction (other): Itching of lower extremities!!!!!

2021-03-08

Systemic reaction (other): Swelling of lower extremities, rash of macular style, skin very reddened with occasional hive. The itching is so irritating. Legs look water logged.

2021-03-09

Systemic reaction (other): Better today! No itching, leg swelling!!

2021-03-10

Systemic reaction (other): No

2021-03-11

Systemic reaction (other): No...fatigue is worse.

Release 5 — day 7, dose 2

2021-03-12

Systemic reaction (other): Itching, fatigue

Release 7 — day 35, dose 2

2021-04-09

Symptoms: Increased edema in lower extremities. Rash increased all over lower extremities, weight gain keeps occurring, dysrhythmias occurs at night, bad headaches. Numbness in left hand and increased pain in left arm.

Healthcare visit (other): Drs office

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	Arrhythmia	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Oedema peripheral	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Weight increased	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Influenza like illness	✓	✓	✓
SRO	Irritability	✓	✓	✓
SRO	Lacrimation increased	✓	✓	✓
SRO	Lip blister	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Rash macular	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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