ZV3-68305-40845

2 vaccinations 6 coded responses 13 check-ins 6 free-text entries 8 call cases

Sex: —
Age at first dose: 56-60
ZIP prefix: 064 / CT
Registered: 2021-01-12

Relationship: Self

Timeline

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

2021-01-07
Dose 1 — Moderna
2021-01-12
Registered in v-safe
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Arthralgia, Dysphagia, Dyspnoea, Oropharyngeal pain, Pain, Pain in extremity, Speech disorder — Feeling: Fair · Site: Pain, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Trouble swallowing, speaking in moderate volume or yelling and taking deep breaths. Pain in my throat that radiates down the shoulder and arm and side of the injection side of my body.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-14
Survey response — day 7, dose 1
MedDRA: Arthralgia, Disturbance in attention, Dizziness, Dysphagia, Neck pain, Pain, Vision blurred — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Trouble concentrating dizziness blurred vision trouble swallowing neck pain that radiates down my shoulder

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-21
Survey response — day 14, dose 1
MedDRA: Rash — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Body rashes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-28
Survey response — day 21, dose 1
MedDRA: Dysphagia, Oropharyngeal pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sore throat and swallowing issues

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-04
Dose 2 — Moderna
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Thirst — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Loss of appetite, thirst.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-06
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-02-06
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Adult check-in
2021-02-09
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-10
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-11
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-18
Survey response — day 14, dose 2
MedDRA: Arthralgia, Chest discomfort, Dysphagia, Lethargy, Pain, Pyrexia, Sleep disorder — 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

Free text: Lethargy, sleep disturbance, joint and body aches, low grade temp, swallowing difficulty, chest tightness and pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Report sent to call center — day 14, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-25
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-02
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-04	Moderna

Call center

8 call center cases

8 successful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-13

Systemic reaction (other): Trouble swallowing, speaking in moderate volume or yelling and taking deep breaths. Pain in my throat that radiates down the shoulder and arm and side of the injection side of my body.

Release 2 — day 7, dose 1

2021-01-14

Systemic reaction (other): Trouble concentrating dizziness blurred vision trouble swallowing neck pain that radiates down my shoulder

Release 2 — day 14, dose 1

2021-01-21

Symptoms: Body rashes

Release 2 — day 21, dose 1

2021-01-28

Symptoms: Sore throat and swallowing issues

Release 3 — days 1–6 daily, dose 2

2021-02-05

Systemic reaction (other): Loss of appetite, thirst.

Release 4 — day 14, dose 2

2021-02-18

Symptoms: Lethargy, sleep disturbance, joint and body aches, low grade temp, swallowing difficulty, chest tightness and pain.

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	Arthralgia	✓	✓	✓
SD	Chest discomfort	✓	✓	✓
SD	Dysphagia	✓	✓	✓
SD	Lethargy	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pyrexia	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Sleep disorder	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Disturbance in attention	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dysphagia	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Speech disorder	✓	✓	✓
SRO	Thirst	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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