ZTB-17576-44268

3 vaccinations 6 coded responses 25 check-ins 6 free-text entries 1 call case

Sex: Female
Age at first dose: 51-55
ZIP prefix: 071 / NJ
Registered: 2021-03-04

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

2021-03-03
Dose 1 — Moderna
2021-03-04
Registered in v-safe
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Redness, Swelling, Itching · Headache

Adult check-in
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising — Feeling: Good · Site: Redness, Swelling, Itching

Free text: Bruising at/near injection site (small bruise)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-10
Health check-in — day 7, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-19
Survey response — day 14, dose 1
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair

Free text: Head pain. Not sure if related to vaccine. Was having head pain on and off before shot, but now it's been bothering me for 5 days straight. Not as bad today as it was in the beginning though.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-31
Dose 2 — Moderna
2021-03-31
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness · None

Adult check-in
2021-04-07
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness · None

Adult check-in
2021-04-14
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-23
Survey response — day 21, dose 2
MedDRA: Back pain, Musculoskeletal chest pain, Pain — Feeling: Good

Free text: Off and on pain on right side of back, radiating to the front rib cage. Started 4/16/21.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-30
Survey response — 3 months, dose 2
MedDRA: Abdominal discomfort, Chills, Lethargy, Muscle spasms, Nausea, Pyrexia — Feeling: Poor · Be unable to do your normal daily activities

Free text: Muscle spasms. Last few days lethargic. Upset stomach & nausea yesterday and today. Chills & fever. 102 degree temp last night.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-29
Survey response — 6 months, dose 2
MedDRA: Asthenia, Dyspnoea, Musculoskeletal chest pain, Pain, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Widespread body pain. Mild shortness of breath off and on. Low energy, chest congestion, pain in rib cage. Not sure if symptoms are related to the covid-19 vaccination.

MedDRA releases: 2024-11 · check-in free text available
2021-09-29
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2021-10-01
Call 1 — Left Voicemail
2022-01-08
Dose 3 — Moderna
2022-04-01
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-07-10
Survey response — 6 months, dose 3
MedDRA: Deafness — Feeling: Fair

Free text: Hearing loss.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-03-31	Moderna
3	2022-01-08	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-09-29	Unsuccessful

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-07

Systemic reaction (other): Bruising at/near injection site (small bruise)

Release 5 — day 14, dose 1

2021-03-19

Symptoms: Head pain. Not sure if related to vaccine. Was having head pain on and off before shot, but now it's been bothering me for 5 days straight. Not as bad today as it was in the beginning though.

Release 7 — day 21, dose 2

2021-04-23

Symptoms: Off and on pain on right side of back, radiating to the front rib cage. Started 4/16/21.

Release 9 — 3 months, dose 2

2021-06-30

Symptoms: Muscle spasms. Last few days lethargic. Upset stomach & nausea yesterday and today. Chills & fever. 102 degree temp last night.

Release 9 — 6 months, dose 2

2021-09-29

Symptoms: Widespread body pain. Mild shortness of breath off and on. Low energy, chest congestion, pain in rib cage. Not sure if symptoms are related to the covid-19 vaccination.

Release 12 — 6 months, dose 3

2022-07-10

Symptoms: Hearing loss.

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
SD	Abdominal discomfort	✓	✓	✓
SD	Asthenia	·	·	✓
SD	Back pain	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Deafness	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Lethargy	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Musculoskeletal chest pain	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SRO	Injection site bruising	✓	✓	✓

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