ZSV-25443-79385

2 vaccinations 18 coded responses 23 check-ins 18 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 908 / CA
Registered: 2021-04-09

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-09
Registered in v-safe
2021-04-09
Dose 1 — Moderna
2021-04-10
Survey response — days 1–6 daily, dose 1
MedDRA: Anxiety, Feeling abnormal, Malaise — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Feel strange. Like getting sick but not yet sick. A little anxious.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Pain in shoulder not injected.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-12
Survey response — days 1–6 daily, dose 1
MedDRA: Blood pressure increased — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Free text: Rise in blood pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal, Heart rate irregular — Feeling: Good

Free text: Brain fog, irregular heart beats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Good

Free text: Lack of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — day 7, dose 1
MedDRA: Dysgeusia — Feeling: Good

Free text: Taste buds affected

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-30
Survey response — day 21, dose 1
MedDRA: Back pain, Neck pain — Feeling: Good

Free text: Neck and low back pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Survey response — day 28, dose 1
MedDRA: Back pain, Feeling abnormal, Headache — Feeling: Good

Free text: Headaches, low back pain, generally not feeling well /normal.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Dose 2 — Moderna
2021-05-14
Survey response — day 0, dose 2
MedDRA: Malaise — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Overall feeling of malaise.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Productive cough — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Phlegm , coughing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-05-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches

Adult check-in
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-05-19
Survey response — days 1–6 daily, dose 2
MedDRA: Dysgeusia — Feeling: Good · Joint pains

Free text: Weird taste

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — days 1–6 daily, dose 2
MedDRA: Secretion discharge — Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Free text: Mucous in sinuses

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Health check-in — day 7, dose 2
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-28
Survey response — day 14, dose 2
MedDRA: Vision blurred, Vitreous floaters — Feeling: Good

Free text: Vision change. More floaters.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Survey response — day 21, dose 2
MedDRA: Depressed mood, Depression — Feeling: Good

Free text: Sadness, depression

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Survey response — day 28, dose 2
MedDRA: Depressed mood, Depression, Hypertension — Feeling: Good

Free text: Depression, sadness. Melancholy. Weepy. High blood pressure .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-21
Survey response — day 35, dose 2
MedDRA: Eye disorder, Office visit, Photopsia, Visual impairment, Vitreous floaters — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Problems w/eyes. Floaters ,flashing lights, seeing shadows · Healthcare visit (other): Opthamologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-21
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-26
Survey response — day 42, dose 2
MedDRA: Heart rate irregular — Feeling: Fair

Free text: Constant Irregular heart beat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-28
Call 1 — Could Not Reach Participant
2021-06-29
Call 2 — Could Not Reach Participant
2021-08-14
Survey response — 3 months, dose 2
MedDRA: Arthralgia — Feeling: Good

Free text: Joint pain in hands,wrists, elbows

MedDRA releases: 2021-09,2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-09	Moderna
2	2021-05-14	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-06-21	Unsuccessful

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-10

Systemic reaction (other): Feel strange. Like getting sick but not yet sick. A little anxious.

2021-04-11

Systemic reaction (other): Pain in shoulder not injected.

2021-04-12

Systemic reaction (other): Rise in blood pressure

2021-04-13

Systemic reaction (other): Brain fog, irregular heart beats

2021-04-15

Systemic reaction (other): Lack of appetite

Release 7 — day 7, dose 1

2021-04-16

Systemic reaction (other): Taste buds affected

Release 8 — day 21, dose 1

2021-04-30

Symptoms: Neck and low back pain.

Release 8 — day 28, dose 1

2021-05-07

Symptoms: Headaches, low back pain, generally not feeling well /normal.

Release 8 — day 0, dose 2

2021-05-14

Systemic reaction (other): Overall feeling of malaise.

Release 8 — days 1–6 daily, dose 2

2021-05-15

Systemic reaction (other): Phlegm , coughing

2021-05-19

Systemic reaction (other): Weird taste

2021-05-20

Systemic reaction (other): Mucous in sinuses

Release 8 — day 14, dose 2

2021-05-28

Symptoms: Vision change. More floaters.

Release 8 — day 21, dose 2

2021-06-04

Symptoms: Sadness, depression

Release 9 — day 28, dose 2

2021-06-11

Symptoms: Depression, sadness. Melancholy. Weepy. High blood pressure .

Release 9 — day 35, dose 2

2021-06-21

Symptoms: Problems w/eyes. Floaters ,flashing lights, seeing shadows

Healthcare visit (other): Opthamologist

Release 9 — day 42, dose 2

2021-06-26

Symptoms: Constant Irregular heart beat

Release 9 — 3 months, dose 2

2021-08-14

Symptoms: Joint pain in hands,wrists, elbows

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	Arthralgia	✓	·	✓
SD	Back pain	✓	✓	✓
SD	Depressed mood	✓	✓	✓
SD	Depression	✓	✓	✓
SD	Eye disorder	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heart rate irregular	✓	✓	✓
SD	Hypertension	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Photopsia	✓	✓	✓
SD	Vision blurred	✓	✓	✓
SD	Visual impairment	✓	✓	✓
SD	Vitreous floaters	✓	✓	✓
SRO	Anxiety	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Blood pressure increased	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dysgeusia	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Heart rate irregular	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Productive cough	✓	✓	✓
SRO	Secretion discharge	✓	✓	✓

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