34Q-21816-27908

4 vaccinations 10 coded responses 33 check-ins 9 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 731 / OK
Registered: 2021-01-14

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

2021-01-14
Registered in v-safe
2021-01-14
Dose 1 — Moderna
2021-01-14
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Good · Site: Pain

Free text: Slight dizziness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-11
Dose 2 — Moderna
2021-02-11
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-12
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Very dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Bronchitis, Cough — Feeling: Good

Free text: Developed a cough; bronchitis.

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: Bronchitis, Chronic obstructive pulmonary disease, Cough, Dyspnoea — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Went to doctor for bronchitis, cough; short off breath due to COPD

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-18
Survey response — day 7, dose 2
MedDRA: Bronchitis, Cough, Pre-existing disease — Feeling: Good · Fatigue or tiredness

Free text: Still coughing from bronchitis

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

Adult check-in
2021-03-04
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
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-25
Survey response — day 42, dose 2
MedDRA: Bronchitis — Feeling: Good

Free text: Bronchitis. One spell that has come back again after 3-4 weeks.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Survey response — 3 months, dose 2
MedDRA: Bronchitis, Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Bronchitis likely caused by allergies to pollens. · Healthcare visit (other): Went to doctors office.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Call 1 — Left Voicemail
2021-06-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-12
Survey response — 6 months, dose 2
MedDRA: Asthma, Condition aggravated, Cough, Dyspnoea, Hospitalisation, Hypersensitivity, Office visit, Pre-existing disease — 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, Hospitalization

Free text: Symptoms: Hospitalized 6:7/21 through 6/10/22 for exaberation of COPD, btrnchial asthma, and allergies. Further treatment 7/30/21 for cough and shortness of breath. · Healthcare visit (other): In office examination.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-12
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)
2021-08-16
Call 2 — Left Voicemail
2021-11-02
Dose 3 — Moderna
2022-01-15
Call 1 — Left Voicemail
2022-02-13
Survey response — 12 months, dose 2
MedDRA: Condition aggravated, Coronary arterial stent insertion, Coronary artery occlusion, Dyspnoea, Hospitalisation, Hypersensitivity, Laboratory test abnormal, Pre-existing disease — 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, Hospitalization

Free text: I had a hospital stay of three days in June. I had a flare-up of COPD/allergies/bronchitis and couldn't breathe. As a follow-up to that, further tests revealed I had major blockage of two cardiac arteries and had two stents placed in them.

MedDRA releases: 2024-11 · check-in free text available
2022-02-13
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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-02-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-08
Dose 4 — Moderna
2022-04-28
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
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: Fair

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

Adult check-in
2023-04-08
Survey response — 12 months, dose 4
MedDRA: Ilium fracture, Living in residential institution — 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, Hospitalization

MedDRA releases: 2024-11
2023-04-08
Report sent to call center — 12 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-04-11
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-14	Moderna
2	2021-02-11	Moderna
3	2021-11-02	Moderna	No
4	2022-04-08	Moderna	No

Call center

5 call center cases

4 successful · 1 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Slight dizziness.

Release 4 — days 1–6 daily, dose 2

2021-02-12

Systemic reaction (other): Very dizzy

2021-02-16

Systemic reaction (other): Developed a cough; bronchitis.

2021-02-17

Systemic reaction (other): Went to doctor for bronchitis, cough; short off breath due to COPD

Release 4 — day 7, dose 2

2021-02-18

Systemic reaction (other): Still coughing from bronchitis

Release 6 — day 42, dose 2

2021-03-25

Symptoms: Bronchitis. One spell that has come back again after 3-4 weeks.

Release 8 — 3 months, dose 2

2021-05-13

Symptoms: Bronchitis likely caused by allergies to pollens.

Healthcare visit (other): Went to doctors office.

Release 9 — 6 months, dose 2

2021-08-12

Symptoms: Hospitalized 6:7/21 through 6/10/22 for exaberation of COPD, btrnchial asthma, and allergies. Further treatment 7/30/21 for cough and shortness of breath.

Healthcare visit (other): In office examination.

Release 11 — 12 months, dose 2

2022-02-13

Symptoms: I had a hospital stay of three days in June. I had a flare-up of COPD/allergies/bronchitis and couldn't breathe. As a follow-up to that, further tests revealed I had major blockage of two cardiac arteries and had two stents placed in them.

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	Living in residential institution	·	·	✓
HCVO	Office visit	✓	✓	✓
SD	Asthma	✓	·	✓
SD	Bronchitis	✓	✓	✓
SD	Condition aggravated	✓	·	✓
SD	Coronary arterial stent insertion	·	·	✓
SD	Coronary artery occlusion	·	·	✓
SD	Cough	✓	·	✓
SD	Dyspnoea	✓	·	✓
SD	Hospitalisation	✓	·	✓
SD	Hypersensitivity	✓	·	✓
SD	Ilium fracture	·	·	✓
SD	Laboratory test abnormal	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SRO	Bronchitis	✓	✓	✓
SRO	Chronic obstructive pulmonary disease	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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