33F-32822-11996

4 vaccinations 12 coded responses 46 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 913 / CA
Registered: 2021-01-21

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

2021-01-21
Registered in v-safe
2021-01-21
Dose 1 — Moderna
2021-01-21
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activities

Free text: Tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
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
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

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: Diplopia — Feeling: Poor · Vomiting · Be unable to work

Free text: Seeing double

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: Fair · Headache, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

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: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-02-25
Health check-in — day 7, dose 2
Feeling: Good · Headache, Fatigue or tiredness

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

Adult check-in
2021-03-11
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-18
Survey response — day 28, dose 2
MedDRA: Headache, Nausea — Feeling: Good

Free text: Nausea & slight headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-01
Survey response — day 42, dose 2
MedDRA: Abdominal distension, Diarrhoea, Gastric disorder — Feeling: Fair · Be unable to do your normal daily activities

Free text: Stomach problems. Dont think its about the vaccine, but I feel full most of the time & some loose stool.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-19
Survey response — 6 months, dose 2
MedDRA: Fatigue, Headache, Respiratory tract congestion, SARS-CoV-2 test negative, Sinusitis — Feeling: Good · Be unable to work or attend school, 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: Headache, fatigue, all stuffed up & feeling worn down. Turned out to be a sinus infection. Covid test negative.

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 work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2021-08-25
Call 1 — Left Voicemail
2021-10-21
Dose 3 — Moderna
2021-10-24
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Fair · Headache

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-28
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-04
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-11
Survey response — day 21, dose 3
MedDRA: Headache — Feeling: Good

Free text: Headache

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Survey response — day 28, dose 3
MedDRA: Emergency care, Fall, Head injury, Headache — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: This has nothing to do with my Booster. I fell & hit my head. Have had a headache ever since. Going to ER tonight.

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2021-11-19
Call 1 — Left Voicemail
2021-11-25
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-20
Survey response — 3 months, dose 3
MedDRA: Fatigue, Headache, Pain — Feeling: Good · 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: Headache, fatigued & achey

MedDRA releases: 2024-11 · check-in free text available
2022-01-20
Report sent to call center — 3 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-01-21
Call 1 — Left Voicemail
2022-01-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-08
Dose 4 — Moderna
2022-04-14
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Headache

Adult check-in
2022-04-15
Survey response — day 7, dose 4
MedDRA: Concussion, Fall — Feeling: Poor · Be unable to work or attend school, 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: Systemic reaction (other): Concussion unrelated to vaccine · Healthcare visit (other): Related to a fall/concussion

MedDRA releases: 2024-11 · check-in free text available
2022-04-15
Report sent to call center — day 7, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2022-04-22
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-22
Call 1 — Left Voicemail
2022-04-29
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-13
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-20
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-08
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-07
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-08
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-18	Moderna
3	2021-10-21	Moderna	No
4	2022-04-08	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): No

2021-01-23

Systemic reaction (other): Tired

Release 4 — days 1–6 daily, dose 2

2021-02-19

Systemic reaction (other): No

2021-02-20

Systemic reaction (other): Seeing double

Release 5 — day 28, dose 2

2021-03-18

Symptoms: Nausea & slight headache

Release 6 — day 42, dose 2

2021-04-01

Symptoms: Stomach problems. Dont think its about the vaccine, but I feel full most of the time & some loose stool.

Release 9 — 6 months, dose 2

2021-08-19

Symptoms: Headache, fatigue, all stuffed up & feeling worn down. Turned out to be a sinus infection. Covid test negative.

Release 10 — days 1–6 daily, dose 3

2021-10-24

Systemic reaction (other): No

Release 10 — day 21, dose 3

2021-11-11

Symptoms: Headache

Release 10 — day 28, dose 3

2021-11-18

Symptoms: This has nothing to do with my Booster. I fell & hit my head. Have had a headache ever since. Going to ER tonight.

Release 10 — 3 months, dose 3

2022-01-20

Symptoms: Headache, fatigued & achey

Release 11 — day 7, dose 4

2022-04-15

Systemic reaction (other): Concussion unrelated to vaccine

Healthcare visit (other): Related to a fall/concussion

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	Concussion	·	·	✓
HCVO	Fall	·	·	✓
SD	Abdominal distension	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Emergency care	·	·	✓
SD	Fall	·	·	✓
SD	Fatigue	✓	·	✓
SD	Gastric disorder	✓	✓	✓
SD	Head injury	·	·	✓
SD	Headache	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Pain	·	·	✓
SD	Respiratory tract congestion	✓	·	✓
SD	SARS-CoV-2 test negative	✓	·	✓
SD	Sinusitis	✓	·	✓
SRO	Concussion	·	·	✓
SRO	Diplopia	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	No adverse event	✓	✓	✓

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