27L-17041-27004

4 vaccinations 12 coded responses 27 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 119 / NY
Registered: 2021-01-30

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

2021-01-22
Dose 1 — Moderna
2021-01-30
Registered in v-safe
2021-01-30
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness, Nausea · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Adult check-in
2021-01-30
Report sent to call center — day 7, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-12
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-19
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Good · Site: Pain · Joint pains

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Neck pain, Odynophagia, Oropharyngeal pain — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches

Free text: Right side of neck sore and throat when I swallow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Night sweats — Feeling: Fair · Site: Swelling, Itching · Headache

Free text: Night sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Joint pains

Adult check-in
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Throat tightness — Feeling: Good · Site: Redness, Swelling, Itching · Joint pains

Free text: Throat feels thick

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-02-26
Health check-in — day 7, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-03-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-29
Survey response — day 35, dose 2
MedDRA: Abdominal discomfort, Gastric ulcer — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Increased abdominal discomfort. Im being treated for a stomach ulcer. Theyve changed my meds.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-02
Survey response — day 42, dose 2
MedDRA: Headache, Rhinorrhoea — Feeling: Fair

Free text: Headache, runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Call 1 — Left Voicemail
2021-10-07
Dose 3 — Moderna
2021-10-27
Survey response — day 14, dose 3
MedDRA: Chills, Condition aggravated, Erythema, Feeling hot, Peripheral swelling, Pre-existing disease, Pyrexia, Respiration abnormal, Tenderness, Tooth extraction — Feeling: Fair · Be unable to do your normal daily activities

Free text: I experience a deep sigh. It happens unexpectedly & with no warning. I've had my teeth extracted. My stomach ulcer seems to be acting up. After 3rd dose I was down for 3 days with fever & chills. Arm was very swollen, red & warm. Still tender.

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — day 21, dose 3
MedDRA: Abdominal pain upper, Rhinorrhoea — Feeling: Fair

Free text: Stomach pain increased Nose running Continue to sigh

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-11
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-18
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-07
Survey response — 3 months, dose 3
MedDRA: Cough, Oropharyngeal pain, Respiratory tract congestion, Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional

Free text: Symptoms: Sore throat, occasionally coughing, some congestion · Healthcare visit (other): Nose swab at drive through at grandson's school

MedDRA releases: 2024-11 · check-in free text available
2022-01-07
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-01-10
Call 1 — Could Not Reach Participant
2022-01-13
Call 2 — Could Not Reach Participant
2022-04-11
Survey response — 6 months, dose 3
MedDRA: Asthenia, Gastric ulcer, Lymph node pain, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Glands in neck sore Stomach ulcer getting worse No energy · Healthcare visit (other): EGD

MedDRA releases: 2024-11 · check-in free text available
2022-04-11
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-12
Call 1 — Left Voicemail
2022-09-14
Dose 4 — Moderna
2022-10-07
Survey response — day 21, dose 4
MedDRA: Ear pain — Feeling: Fair

Free text: I've had an earache for last 4 days

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Survey response — day 28, dose 4
MedDRA: Adverse reaction — Feeling: Fair · Be unable to do your normal daily activities

Free text: Having health issues. Don't know if any are related to booster or not.

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-10-28
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-19	Moderna
3	2021-10-07	Moderna	No
4	2022-09-14	Moderna	No

Call center

4 call center cases

4 unsuccessful

See the call center timeline

Free text

Release 4 — day 0, dose 2

2021-02-19

Systemic reaction (other): No

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): Right side of neck sore and throat when I swallow

2021-02-22

Systemic reaction (other): Night sweats

2021-02-24

Systemic reaction (other): Throat feels thick

Release 6 — day 35, dose 2

2021-03-29

Symptoms: Increased abdominal discomfort. Im being treated for a stomach ulcer. Theyve changed my meds.

Release 6 — day 42, dose 2

2021-04-02

Symptoms: Headache, runny nose

Release 10 — day 14, dose 3

2021-10-27

Symptoms: I experience a deep sigh. It happens unexpectedly & with no warning. I've had my teeth extracted. My stomach ulcer seems to be acting up. After 3rd dose I was down for 3 days with fever & chills. Arm was very swollen, red & warm. Still tender.

Release 10 — day 21, dose 3

2021-10-28

Symptoms: Stomach pain increased Nose running Continue to sigh

Release 10 — 3 months, dose 3

2022-01-07

Symptoms: Sore throat, occasionally coughing, some congestion

Healthcare visit (other): Nose swab at drive through at grandson's school

Release 11 — 6 months, dose 3

2022-04-11

Symptoms: Glands in neck sore Stomach ulcer getting worse No energy

Healthcare visit (other): EGD

Release 12 — day 21, dose 4

2022-10-07

Symptoms: I've had an earache for last 4 days

Release 12 — day 28, dose 4

2022-10-12

Symptoms: Having health issues. Don't know if any are related to booster or not.

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	Abdominal discomfort	✓	✓	✓
SD	Abdominal pain upper	·	·	✓
SD	Adverse reaction	·	·	✓
SD	Asthenia	·	·	✓
SD	Chills	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	Ear pain	·	·	✓
SD	Erythema	·	·	✓
SD	Feeling hot	·	·	✓
SD	Gastric ulcer	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Lymph node pain	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiration abnormal	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	Tenderness	·	·	✓
SD	Tooth extraction	·	·	✓
SRO	Neck pain	✓	✓	✓
SRO	Night sweats	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Odynophagia	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Throat tightness	✓	✓	✓

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