2WS-69697-35731

5 vaccinations 11 coded responses 27 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 802 / CO
Registered: 2021-02-12

Relationship: Self
Race: Black or African American
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-15
Dose 1 — Moderna
2021-02-12
Registered in v-safe
2021-02-12
Dose 2 — Moderna
2021-02-12
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain upper, Night sweats, Pyrexia — Feeling: Poor · Chills, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Have stomach pains daily normally. In 14 February woke up with pajamas wet and believe it was from Fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Chills, Joint pains, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-02-20
Health check-in — day 7, dose 2
Feeling: Fair · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-26
Survey response — day 14, dose 2
MedDRA: Eye pain, Headache, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Headaches and eye pain. Doctor said dry eyes.But headaches is something else? Using eyedrops and eye ointment. · Healthcare visit (other): Eye clinic for emergency checkup

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-05
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-13
Survey response — day 28, dose 2
MedDRA: Arthralgia, Burning sensation, Pain — Feeling: Fair

Free text: My left shoulder hurts all the time near where I got the vaccination and down my arm. Burning or throbbing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 35, dose 2
MedDRA: Arthralgia, Eye pain, Headache, Movement disorder, Pain, Pain in extremity — Feeling: Fair

Free text: Left shoulder and arm hurts when I lift myhands especially sudden movements with myshoulder.occasional eye aches and headaches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Survey response — day 42, dose 2
MedDRA: Abdominal pain, Abdominal pain upper, Arthralgia, Breast pain, Constipation, Eye pain, Fatigue, Headache, Pain in extremity — Feeling: Fair

Free text: Left shoulder and arm continually hurts. And left breast. Abdomen/stomach sore on right side w/constipation. Headache a few times. Tired.Eye hurts with pressure.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Constipation, Cough, Dry eye, Fatigue, Headache, Nausea, Office visit, Pain, Tenderness — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Left shoulder hurts when I try to move different angles. Nausea, coughing, constipation, tired, eye dryness, headache and some tenderness on bottom of left foot arch and where I tieShoe laces. Have addressed some with Drs.and some therapy. · Healthcare visit (other): Drs office.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-17
Call 1 — Left Voicemail
2021-08-16
Survey response — 6 months, dose 2
MedDRA: Abdominal pain, Abdominal pain upper, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Still with pains on right side of belly, stomach · Healthcare visit (other): Pain management dr. , primary care dr.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-16
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-18
Call 1 — Left Voicemail
2021-10-05
Dose 3 — Moderna
2022-04-01
Dose 4 — Pfizer-BioNTech
2022-04-29
Survey response — day 28, dose 4
MedDRA: Abdominal pain, Back pain, Constipation, Cyst, Eye pain, Headache, Incontinence, Myalgia, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: Pain in abdomen,incontinence,back pain, eye and headaches, hand hurts on right up to muscles on right plus a cyst on right hand that bothers. Constipation.

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-07-01
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2022-09-30
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2022-12-19
Dose 5 — Pfizer-BioNTech
2022-12-23
Survey response — days 1–6 daily, dose 5
MedDRA: Abdominal pain, Burning sensation, Cold sweat, Feeling hot, Hyperhidrosis, Pruritus, Unevaluable event, Urinary tract infection — Feeling: Poor · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Urinary track infections, abdominal pain. Itching, burning all over the body. Hot and cold sweat. Running to bathroom often.

MedDRA releases: 2024-11 · check-in free text available
2022-12-23
Report sent to call center — days 1–6 daily, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-25
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Chills, Headache, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site

Free text: No

Adult check-in · check-in free text available
2022-12-26
Survey response — day 7, dose 5
MedDRA: Urinary tract infection — Feeling: Poor · Chills, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Still have urinary track infection and in antibiotics

MedDRA releases: 2024-11 · check-in free text available
2022-12-27
Call 1 — Left Voicemail
2023-01-09
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2023-01-16
Health check-in — day 28, dose 5
Feeling: Fair

Adult check-in
2023-01-23
Health check-in — day 35, dose 5
Feeling: Fair

Adult check-in
2023-01-30
Survey response — day 42, dose 5
MedDRA: Abdominal pain, Bladder pain, Constipation, Fatigue, Unevaluable event, Urinary retention — Feeling: Poor

MedDRA releases: 2024-11
2023-03-20
Health check-in — 3 months, dose 5
Feeling: Fair

Adult check-in
2023-06-19
Health check-in — 6 months, dose 5
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-10-05	Moderna	No
4	2022-04-01	Pfizer-BioNTech	No
5	2022-12-19	Pfizer-BioNTech	No

Call center

4 call center cases

4 unsuccessful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-16

Systemic reaction (other): Have stomach pains daily normally. In 14 February woke up with pajamas wet and believe it was from Fever

Release 4 — day 14, dose 2

2021-02-26

Symptoms: Headaches and eye pain. Doctor said dry eyes.But headaches is something else? Using eyedrops and eye ointment.

Healthcare visit (other): Eye clinic for emergency checkup

Release 5 — day 28, dose 2

2021-03-13

Symptoms: My left shoulder hurts all the time near where I got the vaccination and down my arm. Burning or throbbing.

Release 6 — day 35, dose 2

2021-03-19

Symptoms: Left shoulder and arm hurts when I lift myhands especially sudden movements with myshoulder.occasional eye aches and headaches.

Release 6 — day 42, dose 2

2021-03-26

Symptoms: Left shoulder and arm continually hurts. And left breast. Abdomen/stomach sore on right side w/constipation. Headache a few times. Tired.Eye hurts with pressure.

Release 8 — 3 months, dose 2

2021-05-15

Symptoms: Left shoulder hurts when I try to move different angles. Nausea, coughing, constipation, tired, eye dryness, headache and some tenderness on bottom of left foot arch and where I tieShoe laces. Have addressed some with Drs.and some therapy.

Healthcare visit (other): Drs office.

Release 9 — 6 months, dose 2

2021-08-16

Symptoms: Still with pains on right side of belly, stomach

Healthcare visit (other): Pain management dr. , primary care dr.

Release 11 — day 28, dose 4

2022-04-29

Symptoms: Pain in abdomen,incontinence,back pain, eye and headaches, hand hurts on right up to muscles on right plus a cyst on right hand that bothers. Constipation.

Release 12 — days 1–6 daily, dose 5

2022-12-23

Systemic reaction (other): Urinary track infections, abdominal pain. Itching, burning all over the body. Hot and cold sweat. Running to bathroom often.

2022-12-25

Systemic reaction (other): No

Release 12 — day 7, dose 5

2022-12-26

Systemic reaction (other): Still have urinary track infection and in antibiotics

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	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Back pain	·	·	✓
SD	Bladder pain	·	·	✓
SD	Breast pain	✓	✓	✓
SD	Burning sensation	✓	✓	✓
SD	Constipation	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Cyst	·	·	✓
SD	Dry eye	✓	✓	✓
SD	Eye pain	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Incontinence	·	·	✓
SD	Movement disorder	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Nausea	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Tenderness	✓	✓	✓
SD	Unevaluable event	·	·	✓
SD	Urinary retention	·	·	✓
SRO	Abdominal pain	·	·	✓
SRO	Abdominal pain upper	✓	✓	✓
SRO	Burning sensation	·	·	✓
SRO	Cold sweat	·	·	✓
SRO	Feeling hot	·	·	✓
SRO	Hyperhidrosis	·	·	✓
SRO	Night sweats	✓	✓	✓
SRO	Pruritus	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Unevaluable event	·	·	✓
SRO	Urinary tract infection	·	·	✓

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