29W-16135-47107

5 vaccinations 11 coded responses 33 check-ins 10 free-text entries 7 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 323 / FL
Registered: 2021-01-26

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

2021-01-21
Dose 1 — Moderna
2021-01-26
Registered in v-safe
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-18
Dose 2 — Moderna
2021-02-18
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Night sweats, Pyrexia, Self-medication — Feeling: Good · Site: Redness, Swelling, Itching · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Up until about 6 or 7 this morning i had chills, fevers and night sweats. I took Tylenol up to this point.

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: Good · Site: Swelling, Itching · None

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-25
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-11
Survey response — day 21, dose 2
MedDRA: Fatigue, Insomnia, Somnolence — Feeling: Good

Free text: At first i felt tored and sleepy. Two days i took a cortazone shot in my right knee. Since then i have not been able to sleep. I am completely awake all night and day. This may not have anything to do with the COVID shot but may need reporting.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-19
Survey response — 6 months, dose 2
MedDRA: Pancreatic disorder, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: I have developed problems with my pancreas. · Healthcare visit (other): I have been referred to (b)(6) Clinic.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-19
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

1 call case(s)
2021-10-08
Call successful
Does not wish to fill out VAERS report
2021-11-03
Dose 3 — Moderna
2022-02-18
Survey response — 12 months, dose 2
MedDRA: Gastrointestinal disorder, Office visit, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I am having a lot of stomach problems. I am under the care of (b)(6) Clinic. So far, they have not been able to diagnose the problem. · Healthcare visit (other): Lots of test

MedDRA releases: 2024-11 · check-in free text available
2022-02-18
Report sent to call center — 12 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-24
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-04
Dose 4 — Moderna
2022-04-19
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-25
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-04
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-09
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-06
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-09-19
Dose 5 — Moderna
2022-09-26
Survey response — day 7, dose 5
MedDRA: No adverse event — Feeling: Good · Site: Itching · Headache

Free text:

MedDRA releases: 2024-11 · check-in free text available
2022-10-05
Survey response — day 14, dose 5
MedDRA: Abdominal pain upper, Diarrhoea, Emergency care, Headache, Pain, Vomiting — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I was in the emergency room Monday and Tuesday most of the day and night. I was vomiting, had headaches and today i am having chronic diarrhea. Both dates i have had chronic stomach aches.

MedDRA releases: 2024-11 · check-in free text available
2022-10-05
Report sent to call center — day 14, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-10-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-10
Survey response — day 21, dose 5
MedDRA: Chills, Diarrhoea, Emergency care, Pre-existing disease, Pyrexia, Vomiting — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I have beennto the emergency toom two conservative nights. Additionally, I have been vomiting, having diarrhea and having chills and fever. My diabetic medication was changed on the same week that i took the vaccine shot. So i am unsure if my med

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Report sent to call center — day 21, dose 5
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-10-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-17
Survey response — day 28, dose 5
MedDRA: Diarrhoea, Emergency care, Vomiting — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I had to go to the emergency room october 3 and 4th, 2022. I was vomiting and had diarrhea. I did not have a fever.

MedDRA releases: 2024-11 · check-in free text available
2022-10-17
Report sent to call center — day 28, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-10-18
Call successful
Not applicable - Accidental Reporting
2022-10-24
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-10-31
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-23
Survey response — 3 months, dose 5
MedDRA: Office visit, Pain in extremity, Peripheral swelling — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Symptoms: Legs and feet are swollen and hurting. · Healthcare visit (other): Continuous and ongoing doctor visits.

MedDRA releases: 2024-11 · check-in free text available
2022-12-23
Report sent to call center — 3 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-12-23
Call successful
Does not wish to fill out VAERS report
2023-03-20
Survey response — 6 months, dose 5
MedDRA: Oedema peripheral, Peripheral swelling — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

MedDRA releases: 2024-11
2023-03-20
Report sent to call center — 6 months, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2023-03-22
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-18	Moderna
3	2021-11-03	Moderna	No
4	2022-04-04	Moderna	No
5	2022-09-19	Moderna	No

Call center

7 call center cases

7 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-26

Systemic reaction (other): No

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): Up until about 6 or 7 this morning i had chills, fevers and night sweats. I took Tylenol up to this point.

Release 5 — day 21, dose 2

2021-03-11

Symptoms: At first i felt tored and sleepy. Two days i took a cortazone shot in my right knee. Since then i have not been able to sleep. I am completely awake all night and day. This may not have anything to do with the COVID shot but may need reporting.

Release 9 — 6 months, dose 2

2021-08-19

Symptoms: I have developed problems with my pancreas.

Healthcare visit (other): I have been referred to (b)(6) Clinic.

redacted (b)(6)

Release 11 — 12 months, dose 2

2022-02-18

Symptoms: I am having a lot of stomach problems. I am under the care of (b)(6) Clinic. So far, they have not been able to diagnose the problem.

Healthcare visit (other): Lots of test

redacted (b)(6)

Release 12 — day 7, dose 5

2022-09-26

Release 12 — day 14, dose 5

2022-10-05

Symptoms: I was in the emergency room Monday and Tuesday most of the day and night. I was vomiting, had headaches and today i am having chronic diarrhea. Both dates i have had chronic stomach aches.

Release 12 — day 21, dose 5

2022-10-10

Symptoms: I have beennto the emergency toom two conservative nights. Additionally, I have been vomiting, having diarrhea and having chills and fever. My diabetic medication was changed on the same week that i took the vaccine shot. So i am unsure if my med cut off by CDC

Release 12 — day 28, dose 5

2022-10-17

Symptoms: I had to go to the emergency room october 3 and 4th, 2022. I was vomiting and had diarrhea. I did not have a fever.

Release 12 — 3 months, dose 5

2022-12-23

Symptoms: Legs and feet are swollen and hurting.

Healthcare visit (other): Continuous and ongoing doctor visits.

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	Office visit	·	·	✓
HCVO	Unevaluable event	✓	·	✓
SD	Abdominal pain upper	·	·	✓
SD	Chills	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	·	·	✓
SD	Insomnia	✓	✓	✓
SD	Oedema peripheral	·	·	✓
SD	Office visit	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pancreatic disorder	✓	·	✓
SD	Peripheral swelling	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	·	·	✓
SD	Somnolence	✓	✓	✓
SD	Vomiting	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Night sweats	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Pyrexia	✓	✓	✓
SRO	Self-medication	✓	✓	✓

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