3F8-26959-39985

5 vaccinations 10 coded responses 40 check-ins 10 free-text entries 0 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 850 / AZ
Registered: 2021-03-10

Relationship: Self
Race: White
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

2021-03-10
Registered in v-safe
2021-03-10
Dose 1 — Moderna
2021-03-10
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 1
MedDRA: Eye pain, Swelling of eyelid — Feeling: Fair · Site: Pain · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Eye pain and eyelid swelling. Both eyes/upper and lower lids. I have no dermal fillers .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — days 1–6 daily, dose 1
MedDRA: Erythema, Eye pain, Eye swelling, Rash, Swelling face — Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Eyes are still painful and swollen. Swelling on left eye has intensified into my cheek.left side of face red and rashy. I have NO dermal fillers. If continues I will need to seek medical attention.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Survey response — days 1–6 daily, dose 1
MedDRA: Blepharitis, Eye pain, Eye swelling, Swelling face — Feeling: Fair · Rash, not including the immediate area around the injection site

Free text: Left eye still painful and swollen. Left lower lid stillInflamed and puffy cheek.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-31
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-08
Dose 2 — Moderna
2021-04-14
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy, Pain in extremity — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: I have swollen lymph nodes near under arm on side I received the vaccine. Also leg pain on opposite side.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 7, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Severe pain leg.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-13
Survey response — day 35, dose 2
MedDRA: Hyperaesthesia, Tenderness — Feeling: Fair

Free text: Tenderness to inside of arm that I had injection. Sensitive to touch.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-10-24
Dose 3 — Moderna
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · Headache, Joint pains

Adult check-in
2021-10-31
Health check-in — day 7, dose 3
Feeling: Fair · Site: Swelling · Joint pains

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-23
Survey response — 3 months, dose 3
MedDRA: Headache, Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair

Free text: Sore throat, congestion and headache.

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Dose 4 — Moderna
2022-04-15
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-24
Survey response — day 14, dose 4
MedDRA: Arthralgia, Fatigue, Tinnitus — Feeling: Fair

Free text: Fatigue. Joint pain. Worsening of ringing in my ears

MedDRA releases: 2024-11 · check-in free text available
2022-05-06
Survey response — day 28, dose 4
MedDRA: Glossitis, Noninfective gingivitis, Oral mucosal eruption, Tongue eruption — Feeling: Fair

Free text: Lesions and inflammation to right side of tongue and gums.

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Health check-in — day 35, dose 4
Feeling: Fair

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

Adult check-in
2022-09-26
Dose 5 — Moderna
Co-administered: Flu
2022-10-07
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2022-10-07
Health check-in — day 7, dose 5
Feeling: Fair · None

Adult check-in
2022-10-10
Health check-in — day 14, dose 5
Feeling: Fair

Adult check-in
2022-10-17
Survey response — day 21, dose 5
MedDRA: Headache — Feeling: Poor · Be unable to do your normal daily activities

Free text: Headache

MedDRA releases: 2024-11 · check-in free text available
2022-10-24
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-31
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-07
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-26
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-27
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Moderna
2	2021-04-08	Moderna
3	2021-10-24	Moderna	No
4	2022-04-08	Moderna	No
5	2022-09-26	Moderna	Flu

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-13

Systemic reaction (other): Eye pain and eyelid swelling. Both eyes/upper and lower lids. I have no dermal fillers .

2021-03-14

Systemic reaction (other): Eyes are still painful and swollen. Swelling on left eye has intensified into my cheek.left side of face red and rashy. I have NO dermal fillers. If continues I will need to seek medical attention.

2021-03-15

Systemic reaction (other): Left eye still painful and swollen. Left lower lid stillInflamed and puffy cheek.

Release 7 — days 1–6 daily, dose 2

2021-04-14

Systemic reaction (other): I have swollen lymph nodes near under arm on side I received the vaccine. Also leg pain on opposite side.

Release 7 — day 7, dose 2

2021-04-15

Systemic reaction (other): Severe pain leg.

Release 8 — day 35, dose 2

2021-05-13

Symptoms: Tenderness to inside of arm that I had injection. Sensitive to touch.

Release 11 — 3 months, dose 3

2022-01-23

Symptoms: Sore throat, congestion and headache.

Release 11 — day 14, dose 4

2022-04-24

Symptoms: Fatigue. Joint pain. Worsening of ringing in my ears

Release 11 — day 28, dose 4

2022-05-06

Symptoms: Lesions and inflammation to right side of tongue and gums.

Release 12 — day 21, dose 5

2022-10-17

Symptoms: Headache

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	Arthralgia	·	·	✓
SD	Fatigue	·	·	✓
SD	Glossitis	·	·	✓
SD	Headache	·	·	✓
SD	Hyperaesthesia	✓	✓	✓
SD	Noninfective gingivitis	·	·	✓
SD	Oral mucosal eruption	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Tenderness	✓	✓	✓
SD	Tinnitus	·	·	✓
SD	Tongue eruption	·	·	✓
SRO	Blepharitis	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Swelling face	✓	✓	✓
SRO	Swelling of eyelid	✓	✓	✓

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