22D-73235-64583

2 vaccinations 9 coded responses 18 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 317 / GA
Registered: 2021-01-26

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

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-01-14
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Survey response — day 7, dose 1
MedDRA: Chest discomfort, Chest pain, Dizziness, Dizziness postural, Headache, Paraesthesia — Feeling: Poor · Headache, Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: tingling hot pain chest off and on, severe pain in back of head occasionally, dizziness when standing up and when lying down occasionally.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — day 14, dose 1
MedDRA: Eye pain, Headache — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headaches, pain in both eyes, pain in the back of the head and pain on the left upper part of the head, also still having pain in chest area on the left side. Same symptoms reported following vaccine after 1-14-21 vaccine but more severe.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Headache

Free text: no

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Itching · Headache, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Eye pain, Pain in jaw — Feeling: Fair · Site: Pain, Itching · Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: Eye pain and pain in right jaw and ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain, Pain in jaw — Feeling: Fair · Site: Pain, Itching · Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: eye pain, jaw pain,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain, Eye pain — Feeling: Fair · Site: Itching · Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: right ear pain and eye pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Eye pain, Headache, Pain in jaw — Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches

Free text: eye pain, pain in the back and side of the head, and left jaw pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — day 7, dose 2
MedDRA: Eye pain — Feeling: Good · Site: Pain, Itching · Headache, Muscle or body aches

Free text: eye pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-18
Survey response — day 35, dose 2
MedDRA: Ageusia, Bradyphrenia, Chest pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: tingling pain in chest area on the left, feeling sluggish, lost of taste

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-12
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-16
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna

Free text

Release 2 — day 7, dose 1

2021-01-26

Systemic reaction (other): tingling hot pain chest off and on, severe pain in back of head occasionally, dizziness when standing up and when lying down occasionally.

Release 3 — day 14, dose 1

2021-01-29

Symptoms: Headaches, pain in both eyes, pain in the back of the head and pain on the left upper part of the head, also still having pain in chest area on the left side. Same symptoms reported following vaccine after 1-14-21 vaccine but more severe.

Release 4 — day 0, dose 2

2021-02-11

Systemic reaction (other): no

Release 4 — days 1–6 daily, dose 2

2021-02-13

Systemic reaction (other): Eye pain and pain in right jaw and ear

2021-02-14

Systemic reaction (other): eye pain, jaw pain,

2021-02-15

Systemic reaction (other): right ear pain and eye pain

2021-02-17

Systemic reaction (other): eye pain, pain in the back and side of the head, and left jaw pain

Release 4 — day 7, dose 2

2021-02-18

Systemic reaction (other): eye pain

Release 5 — day 35, dose 2

2021-03-18

Symptoms: tingling pain in chest area on the left, feeling sluggish, lost of taste

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	Ageusia	✓	✓	✓
SD	Bradyphrenia	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Eye pain	✓	✓	✓
SD	Headache	✓	✓	✓
SRO	Back pain	✓	✓	✓
SRO	Chest discomfort	✓	·	✓
SRO	Chest pain	✓	✓	✓
SRO	Dizziness	○	✓	○
SRO	Dizziness postural	✓	·	✓
SRO	Ear pain	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pain in jaw	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓

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