38M-16047-86669

3 vaccinations 12 coded responses 23 check-ins 12 free-text entries 2 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 044 / ME
Registered: 2021-01-08

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

2021-01-07
Dose 1 — Moderna
2021-01-08
Registered in v-safe
2021-01-08
Survey response — days 1–6 daily, dose 1
MedDRA: Vision blurred — Feeling: Good · Site: Pain, Itching

Free text: Blurred vision

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Survey response — days 1–6 daily, dose 1
MedDRA: Bladder pain — Feeling: Poor · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Bladder pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-14
Survey response — day 7, dose 1
MedDRA: Pre-existing disease — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Diarrhea

Free text: I am on Humira do you have ankylosing spondylitis diverticulitis and celiac

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — day 14, dose 1
MedDRA: Dizziness, Influenza, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities

Free text: On 1/16/21 I got the same flu symptoms as I did on the 13th .Dizzy and un able to focus . I am on Huimara and looks like I had a delayed reaction . Felt good on 14th and 15th

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Survey response — day 21, dose 1
MedDRA: Blood pressure increased — Feeling: Fair

Free text: Elevated blood pressure over the last couple weeks

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Dose 2 — Moderna
2021-02-04
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Itching · None

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary mass, Axillary pain, Oedema peripheral — Feeling: Poor · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Large lump under arm that vaccine was given in ... Hurts to touch

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Lymphadenopathy, Pre-existing disease, Spinal pain — Feeling: Poor · Site: Pain, Swelling · Joint pains, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Free text: Very swollen lymph node under arm size of a golf ball, Severe pain all night in shoulders and spine. I have ankylosing spondylitis and I am on Humira. The pain was almost unbearable and I am use to pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · Headache, Diarrhea · Be unable to work

Free text: Golf ball size lymph nodes under vaccine arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling · Diarrhea

Adult check-in
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Fair · Site: Pain, Itching

Free text: Itching ...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-25
Survey response — day 21, dose 2
MedDRA: Chills, Fatigue, Feeling abnormal — Feeling: Fair

Free text: Over all odd feeling ... fatigue and chills

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

Adult check-in
2021-03-11
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-18
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-06
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-23
Dose 3 — Moderna
2021-11-23
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-02-23
Survey response — 6 months, dose 3
MedDRA: Dyskinesia — Feeling: Fair

Free text: Jerking motions out of the blue

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Survey response — 12 months, dose 3
MedDRA: Amnesia, Gastrointestinal disorder, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Memory loss Stomach issues · Healthcare visit (other): Doctor office

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-08-26
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-04	Moderna
3	2021-08-23	Moderna	No

Call center

2 call center cases

1 unsuccessful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-08

Systemic reaction (other): Blurred vision

2021-01-13

Systemic reaction (other): Bladder pain

Release 2 — day 7, dose 1

2021-01-14

Systemic reaction (other): I am on Humira do you have ankylosing spondylitis diverticulitis and celiac

Release 2 — day 14, dose 1

2021-01-21

Symptoms: On 1/16/21 I got the same flu symptoms as I did on the 13th .Dizzy and un able to focus . I am on Huimara and looks like I had a delayed reaction . Felt good on 14th and 15th

Release 3 — day 21, dose 1

2021-01-28

Symptoms: Elevated blood pressure over the last couple weeks

Release 3 — days 1–6 daily, dose 2

2021-02-05

Systemic reaction (other): Large lump under arm that vaccine was given in ... Hurts to touch

2021-02-06

Systemic reaction (other): Very swollen lymph node under arm size of a golf ball, Severe pain all night in shoulders and spine. I have ankylosing spondylitis and I am on Humira. The pain was almost unbearable and I am use to pain

2021-02-07

Systemic reaction (other): Golf ball size lymph nodes under vaccine arm

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Itching ...

Release 4 — day 21, dose 2

2021-02-25

Symptoms: Over all odd feeling ... fatigue and chills

Release 11 — 6 months, dose 3

2022-02-23

Symptoms: Jerking motions out of the blue

Release 12 — 12 months, dose 3

2022-08-25

Symptoms: Memory loss Stomach issues

Healthcare visit (other): Doctor office

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	·	·	✓
SD	Amnesia	·	·	✓
SD	Blood pressure increased	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyskinesia	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Influenza	✓	✓	✓
SD	Vision blurred	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Axillary mass	✓	✓	✓
SRO	Axillary pain	✓	✓	✓
SRO	Bladder pain	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Oedema peripheral	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Spinal pain	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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