36J-11010-12551

4 vaccinations 10 coded responses 30 check-ins 10 free-text entries 4 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 983 / WA
Registered: 2021-02-19

Relationship: Self
Race: Other
Ethnicity: N/A

Timeline

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

2021-02-09
Dose 1 — Moderna
2021-02-19
Registered in v-safe
2021-02-19
Survey response — day 7, dose 1
MedDRA: Hepatic pain, Renal pain, Unevaluable event — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Pain around kidney and liver areas · Healthcare visit (other): Called doc today 2/19/21 to get an appt.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Report sent to call center — day 7, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-23
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-03-02
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-03-09
Dose 2 — Moderna
2021-03-09
Survey response — day 0, dose 2
MedDRA: Rhinorrhoea — Feeling: Poor · Site: Pain, Swelling · Fever · Fatigue or tiredness

Free text: Runny nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Fair · Joint pains, Muscle or body aches

Free text: Systemic itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-03-23
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-30
Survey response — day 21, dose 2
MedDRA: Arthralgia, Injection site pain, Myalgia, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: Muscle and joint pain. Increased pain at injection site and injection arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — day 28, dose 2
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities

Free text: Gout fibromyalgia and lymphedema flared up after last moderna to the point I need medical intervention

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-20
Survey response — day 42, dose 2
MedDRA: Injection site pain, Pain in extremity, Peripheral swelling — Feeling: Fair

Free text: Pain and swelling at injection site and arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-06
Call 1 — Could Not Reach Participant
2021-08-11
Call 2 — Left Voicemail
2021-08-17
Call 3 — Left Voicemail
2021-08-19
Dose 3 — Moderna
2021-09-07
Survey response — 6 months, dose 2
MedDRA: Fatigue, Injection site cellulitis — Feeling: Fair

Free text: General fatigue a bit of cellulitis at the injection site after 3rd moderna.

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

Free text: Headaches feverish

MedDRA releases: 2024-11 · check-in free text available
2021-11-18
Report sent to call center — 3 months, 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 successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-17
Survey response — 6 months, dose 3
MedDRA: Hypoaesthesia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Numbness in extremities

MedDRA releases: 2024-11 · check-in free text available
2022-02-17
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)
2022-02-18
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-30
Dose 4 — Moderna
2022-05-02
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-03
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-05-04
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-05-05
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-05-06
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Abdominal pain

Adult check-in
2022-05-07
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-05-14
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-21
Health check-in — day 21, dose 4
Feeling: Good

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

Adult check-in
2022-06-04
Survey response — day 35, dose 4
MedDRA: Ear pain, Oropharyngeal pain, Pyrexia — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sore throat fever ear ache

MedDRA releases: 2024-11 · check-in free text available
2022-06-04
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-06-06
Call 1 — Left Voicemail
2022-06-08
Call 2 — Could Not Reach Participant

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-09	Moderna
2	2021-03-09	Moderna
3	2021-08-19	Moderna	No
4	2022-04-30	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — day 7, dose 1

2021-02-19

Systemic reaction (other): Pain around kidney and liver areas

Healthcare visit (other): Called doc today 2/19/21 to get an appt.

Release 5 — day 0, dose 2

2021-03-09

Systemic reaction (other): Runny nose

Release 5 — days 1–6 daily, dose 2

2021-03-15

Systemic reaction (other): Systemic itching

Release 6 — day 21, dose 2

2021-03-30

Symptoms: Muscle and joint pain. Increased pain at injection site and injection arm

Release 7 — day 28, dose 2

2021-04-06

Symptoms: Gout fibromyalgia and lymphedema flared up after last moderna to the point I need medical intervention

Release 7 — day 42, dose 2

2021-04-20

Symptoms: Pain and swelling at injection site and arm

Release 9 — 6 months, dose 2

2021-09-07

Symptoms: General fatigue a bit of cellulitis at the injection site after 3rd moderna.

Release 10 — 3 months, dose 3

2021-11-18

Symptoms: Headaches feverish

Release 11 — 6 months, dose 3

2022-02-17

Symptoms: Numbness in extremities

Release 11 — day 35, dose 4

2022-06-04

Symptoms: Sore throat fever ear ache

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	Arthralgia	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Ear pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Injection site cellulitis	·	·	✓
SD	Injection site pain	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SRO	Hepatic pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Renal pain	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓

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