ZTW-74268-22535

3 vaccinations 8 coded responses 29 check-ins 8 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 436 / OH
Registered: 2021-01-06

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

2021-01-06
Registered in v-safe
2021-01-06
Dose 1 — Moderna
2021-01-06
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-03
Dose 2 — Moderna
2021-02-03
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-04
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling abnormal — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-24
Survey response — day 21, dose 2
MedDRA: Body temperature decreased, Headache — Feeling: Good

Free text: Headache and low grade temp

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Survey response — day 28, dose 2
MedDRA: Chest discomfort, Dizziness, Palpitations — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Palpitations, chest pressure, dizziness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-03
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-07
Survey response — 3 months, dose 2
MedDRA: Electrocardiogram ambulatory abnormal, Palpitations, Supraventricular extrasystoles — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Palpitations and abnormal Holter monitor. Supraventricular beats.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-24
Call successful
Does not wish to fill out VAERS report
2021-08-06
Survey response — 6 months, dose 2
MedDRA: Eye pruritus, Pre-existing disease, Rhinorrhoea — Feeling: Fair

Free text: Seasonal allergies. Runny nose, itchy eyes. Treating w nasal spray. Unrelated to vaccine.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-02-03
Survey response — 12 months, dose 2
MedDRA: Colonoscopy abnormal, Gastric polyps, Large intestine polyp, Oesophagogastroduodenoscopy abnormal — Feeling: Good

Free text: Stomach and colon polyps found on EGD and colonoscopy, performed 1/28/22

MedDRA releases: 2024-11 · check-in free text available
2022-03-10
Dose 3 — Moderna
2022-04-27
Survey response — day 42, dose 3
MedDRA: Brain fog, Chills, Fatigue, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: After receiving booster, had fever, chills, brain fog, fatigue for 2 days

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
Survey response — 3 months, dose 3
MedDRA: Arthropod bite, Pruritus, Unevaluable event, Vaccine positive rechallenge — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Not sure of any correlation, but starting last summer (after the 1st 2 doses) and reappeared again this year (after the booster), I experience reactions to mosquito/bug bites. Intense itching, only relieved by rx. · Healthcare visit (other): Prescription skin cream.

MedDRA releases: 2024-11 · check-in free text available
2022-06-09
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-06-10
Call 1 — Left Voicemail
2022-09-08
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-06	Moderna
2	2021-02-03	Moderna
3	2022-03-10	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2021-03-03	Successful	Does not wish to fill out VAERS report
2021-05-07	Successful 2021-06-24	Does not wish to fill out VAERS report
2022-06-09	Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-04

Systemic reaction (other): Brain fog

Release 4 — day 21, dose 2

2021-02-24

Symptoms: Headache and low grade temp

Release 4 — day 28, dose 2

2021-03-03

Symptoms: Palpitations, chest pressure, dizziness.

Release 8 — 3 months, dose 2

2021-05-07

Symptoms: Palpitations and abnormal Holter monitor. Supraventricular beats.

Release 9 — 6 months, dose 2

2021-08-06

Symptoms: Seasonal allergies. Runny nose, itchy eyes. Treating w nasal spray. Unrelated to vaccine.

Release 11 — 12 months, dose 2

2022-02-03

Symptoms: Stomach and colon polyps found on EGD and colonoscopy, performed 1/28/22

Release 11 — day 42, dose 3

2022-04-27

Symptoms: After receiving booster, had fever, chills, brain fog, fatigue for 2 days

Release 11 — 3 months, dose 3

2022-06-09

Symptoms: Not sure of any correlation, but starting last summer (after the 1st 2 doses) and reappeared again this year (after the booster), I experience reactions to mosquito/bug bites. Intense itching, only relieved by rx.

Healthcare visit (other): Prescription skin cream.

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	Unevaluable event	·	·	✓
SD	Arthropod bite	·	·	✓
SD	Body temperature decreased	✓	✓	✓
SD	Brain fog	·	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Chills	·	·	✓
SD	Colonoscopy abnormal	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Electrocardiogram ambulatory abnormal	✓	✓	✓
SD	Eye pruritus	✓	·	✓
SD	Fatigue	·	·	✓
SD	Gastric polyps	·	·	✓
SD	Headache	✓	✓	✓
SD	Large intestine polyp	·	·	✓
SD	Oesophagogastroduodenoscopy abnormal	·	·	✓
SD	Palpitations	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Pruritus	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	✓	·	✓
SD	Supraventricular extrasystoles	✓	✓	✓
SD	Vaccine positive rechallenge	·	·	✓
SRO	Feeling abnormal	✓	✓	✓

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