3BL-70498-07769

2 vaccinations 14 coded responses 23 check-ins 14 free-text entries 0 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 601 / IL
Registered: 2021-01-23

Relationship: Self
Race: Multiracial
Ethnicity: Not Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-01-22
Dose 1 — Moderna
2021-01-23
Registered in v-safe
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Oedema peripheral — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Increased ankle edema

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Respiratory tract congestion, Rhinorrhoea, Sneezing — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sneezing and runny nose congestion in larynx in am

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-27
Survey response — days 1–6 daily, dose 1
MedDRA: Atrial fibrillation — Feeling: Fair · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Atrial fibrillation rate higher

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-29
Health check-in — day 7, dose 1
Feeling: Good · Joint pains

Adult check-in
2021-02-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-12
Survey response — day 21, dose 1
MedDRA: Epistaxis — Feeling: Good · Be unable to do your normal daily activities

Free text: Nose bleed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Dose 2 — Moderna
2021-02-19
Survey response — day 0, dose 2
MedDRA: Decreased appetite, Fatigue — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Loss of appetite and tired

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: Cough — Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Insomnia — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Unable to sleep during night and not sleepy during the day Will attempt to nap in afternoon

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Epistaxis — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Nose bleed last night minimal

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-26
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-05
Survey response — day 14, dose 2
MedDRA: Nausea — Feeling: Good · Be unable to do your normal daily activities

Free text: Severe nausea one day yesterday

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 21, dose 2
MedDRA: Blood pressure systolic decreased, Dizziness — Feeling: Good · Be unable to do your normal daily activities

Free text: Systolic bp below 90 two days this week and dizzy episode one day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 28, dose 2
MedDRA: Abdominal pain upper, Dyspepsia, Dyspnoea exertional, Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: More tired or short of breath when walking. One episode of upper abdominal pain and indigestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-03
Survey response — day 42, dose 2
MedDRA: Dacryocanaliculitis, Eye infection — Feeling: Good · Be unable to do your normal daily activities

Free text: Have lt tear duct infection on eye antibiotic drops and oral antibiotics

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-23
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-08-20
Survey response — 6 months, dose 2
MedDRA: Cardiac disorder — Feeling: Fair

Free text: Heart related

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-02-19
Survey response — 12 months, dose 2
MedDRA: Back pain, Body temperature increased, Chills, Musculoskeletal discomfort — Feeling: Fair · Be unable to do your normal daily activities

Free text: Chills 12 hours past injection temp 99.9 with small lower back pain when standing up slight upper neck in back discomfort

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-19	Moderna

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-23

Systemic reaction (other): Increased ankle edema

2021-01-25

Systemic reaction (other): Sneezing and runny nose congestion in larynx in am

2021-01-27

Systemic reaction (other): Atrial fibrillation rate higher

Release 4 — day 21, dose 1

2021-02-12

Symptoms: Nose bleed

Release 4 — day 0, dose 2

2021-02-19

Systemic reaction (other): Loss of appetite and tired

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): Cough

2021-02-21

Systemic reaction (other): Unable to sleep during night and not sleepy during the day Will attempt to nap in afternoon

2021-02-22

Systemic reaction (other): Nose bleed last night minimal

Release 5 — day 14, dose 2

2021-03-05

Symptoms: Severe nausea one day yesterday

Release 5 — day 21, dose 2

2021-03-12

Symptoms: Systolic bp below 90 two days this week and dizzy episode one day

Release 5 — day 28, dose 2

2021-03-19

Symptoms: More tired or short of breath when walking. One episode of upper abdominal pain and indigestion

Release 6 — day 42, dose 2

2021-04-03

Symptoms: Have lt tear duct infection on eye antibiotic drops and oral antibiotics

Release 9 — 6 months, dose 2

2021-08-20

Symptoms: Heart related

Release 11 — 12 months, dose 2

2022-02-19

Symptoms: Chills 12 hours past injection temp 99.9 with small lower back pain when standing up slight upper neck in back discomfort

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
SD	Abdominal pain upper	✓	✓	✓
SD	Back pain	·	·	✓
SD	Blood pressure systolic decreased	○	✓	○
SD	Body temperature increased	·	·	✓
SD	Cardiac disorder	✓	·	✓
SD	Chills	·	·	✓
SD	Dacryocanaliculitis	✓	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspepsia	✓	✓	✓
SD	Dyspnoea exertional	✓	✓	✓
SD	Epistaxis	✓	✓	✓
SD	Eye infection	○	✓	○
SD	Fatigue	✓	✓	✓
SD	Musculoskeletal discomfort	·	·	✓
SD	Nausea	✓	✓	✓
SRO	Atrial fibrillation	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Epistaxis	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Oedema peripheral	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Rhinorrhoea	✓	✓	✓
SRO	Sneezing	✓	✓	✓

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