ZS9-31626-74317
5 vaccinations
13 coded responses
61 check-ins
12 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 864 / AZ
- Registered
- 2021-03-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-12
Dose 1 — Moderna
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2021-03-13
Registered in v-safe
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2021-03-13
Survey response — days 1–6 daily, dose 1MedDRA: Paraesthesia — Feeling: Fair · Fatigue or tirednessFree text: A little pins and needles sensations throughout my bodyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-14
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
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2021-03-26
Survey response — day 14, dose 1MedDRA: Herpes zoster, Pain — Feeling: GoodFree text: I dont know if it is a reaction or not but Ive started getting little sores all over. They are just small and start out as bumps then open up. They hurt like shingles but they are all over instead of one side of the body. they are very spreadMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-02
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2021-04-09
Dose 2 — Moderna
- 2021-04-09
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2021-04-10
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness, Tinnitus — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: a little light headed and ears are ringingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-12
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue, Headache — Feeling: Good · HeadacheFree text: I missed my report yesterday. Today Im really fine. Yesterday I still had a bit of a headache and was very tired.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-13
- 2021-04-14
- 2021-04-15
- 2021-04-16
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2021-04-23
Survey response — day 14, dose 2MedDRA: Cold sweat, Feeling hot — Feeling: FairFree text: Dont know if I just ate something or what. Ive had some intestinal problems today and am feeling hot and clammy. Temp is 99.4 with a digital thermo scan ear thermometerMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-30
- 2021-05-07
- 2021-05-14
- 2021-05-21
- 2021-07-09
- 2021-10-08
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2021-10-29
Dose 3 — Moderna
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2021-10-30
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-10-31
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2021-11-01
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Fever · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-11-02
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fever · Headache, Muscle or body achesAdult check-in
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
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2021-11-19
Survey response — day 21, dose 3MedDRA: Diarrhoea, Flatulence — Feeling: GoodFree text: A little diarrhea for 2 days. With very gassy stomach.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-27
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2021-12-04
Survey response — day 35, dose 3MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activitiesFree text: I get tired quickly and a lot.MedDRA releases: 2024-11 · check-in free text available
- 2021-12-10
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2022-01-28
Survey response — 3 months, dose 3MedDRA: Headache, Oropharyngeal pain — Feeling: Good · Be unable to do your normal daily activitiesFree text: sore throat, headache,MedDRA releases: 2024-11 · check-in free text available
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2022-04-22
Dose 4 — Moderna
- 2022-04-23
- 2022-04-24
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2022-04-25
Survey response — days 1–6 daily, dose 4MedDRA: Abdominal discomfort — Feeling: Fair · DiarrheaFree text: very mild stomach upsetMedDRA releases: 2024-11 · check-in free text available
- 2022-04-26
- 2022-04-27
- 2022-04-28
- 2022-04-29
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2022-05-06
Survey response — day 14, dose 4MedDRA: Diarrhoea — Feeling: Good · Be unable to do your normal daily activitiesFree text: Diarrhea - but I think it was from something I ate. Not the vaccine.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-06-03
- 2022-07-22
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2022-09-22
Dose 5 — Moderna
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2022-09-25
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Redness, Itching · Fatigue or tirednessAdult check-in
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2022-09-26
Survey response — days 1–6 daily, dose 5MedDRA: Injection site erythema, Injection site pruritus, Rash macular — Feeling: Fair · Site: Itching · Fatigue or tirednessFree text: The redness seems to have gone away but it is still itching. The redness and itching was about a 2-3 inch square Blotch starting 4 inches below the injection.MedDRA releases: 2024-11 · check-in free text available
- 2022-09-27
- 2022-09-28
- 2022-09-29
- 2022-10-06
- 2022-10-13
- 2022-10-22
- 2022-10-27
- 2022-11-03
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2022-12-22
Survey response — 3 months, dose 5MedDRA: Nasopharyngitis, Office visit, Pre-existing disease — 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 professionalFree text: Symptoms: I had a head cold or allergies for about 3 days last week · Healthcare visit (other): Dr office visitMedDRA releases: 2024-11 · check-in free text available
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2022-12-22
Report sent to call center — 3 months, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2022-12-23
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2022-12-23
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2023-03-23
Survey response — 6 months, dose 5MedDRA: SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend schoolMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-12 | Moderna | |
| 2 | 2021-04-09 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-04-22 | Moderna | No |
| 5 | 2022-09-22 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-12-22 | Successful 2022-12-23 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): A little pins and needles sensations throughout my body
Release 6 — day 14, dose 1
Symptoms: I dont know if it is a reaction or not but Ive started getting little sores all over. They are just small and start out as bumps then open up. They hurt like shingles but they are all over instead of one side of the body. they are very spread
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): a little light headed and ears are ringing
Systemic reaction (other): I missed my report yesterday. Today Im really fine. Yesterday I still had a bit of a headache and was very tired.
Release 7 — day 14, dose 2
Symptoms: Dont know if I just ate something or what. Ive had some intestinal problems today and am feeling hot and clammy. Temp is 99.4 with a digital thermo scan ear thermometer
Release 10 — day 21, dose 3
Symptoms: A little diarrhea for 2 days. With very gassy stomach.
Release 10 — day 35, dose 3
Symptoms: I get tired quickly and a lot.
Release 11 — 3 months, dose 3
Symptoms: sore throat, headache,
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): very mild stomach upset
Release 11 — day 14, dose 4
Symptoms: Diarrhea - but I think it was from something I ate. Not the vaccine.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): The redness seems to have gone away but it is still itching. The redness and itching was about a 2-3 inch square Blotch starting 4 inches below the injection.
Release 12 — 3 months, dose 5
Symptoms: I had a head cold or allergies for about 3 days last week
Healthcare visit (other): Dr office visit
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 | Cold sweat | ✓ | ✓ | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Feeling hot | ✓ | ✓ | ✓ |
| SD | Flatulence | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Herpes zoster | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Abdominal discomfort | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | · | · | ✓ |
| SRO | Injection site pruritus | · | · | ✓ |
| SRO | Paraesthesia | ✓ | ✓ | ✓ |
| SRO | Rash macular | · | · | ✓ |
| SRO | Tinnitus | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release