3HV-63032-65753

2 vaccinations 9 coded responses 16 check-ins 9 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 200 / DC
Registered: 2021-09-08

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-08-08
Dose 1 — Moderna
2021-09-08
Registered in v-safe
2021-09-08
Dose 2 — Moderna
2021-09-08
Survey response — day 0, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-09-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-09-10
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pruritus, Headache, Ocular hyperaemia, Periorbital swelling — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: For about 2 hours my head ached really badly and my eyes were itchy, blood red and very puffy.

MedDRA releases: 2024-11 · check-in free text available
2021-09-11
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Equilibrium is off today. At times I lose balance

MedDRA releases: 2024-11 · check-in free text available
2021-09-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Headache, Nausea

Adult check-in
2021-09-13
Survey response — days 1–6 daily, dose 2
MedDRA: Nausea — Feeling: Poor · Site: Itching · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Constantly feeling excessive nause. Especially when I start to.eat.

MedDRA releases: 2024-11 · check-in free text available
2021-09-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-09-15
Health check-in — day 7, dose 2
Feeling: Good · Headache, Nausea

Adult check-in
2021-09-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-09-29
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-10-06
Survey response — day 28, dose 2
MedDRA: Chills, Office visit, Pyrexia, SARS-CoV-2 test — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Chills then fever. I went to urgent care center and took COVID test. Waiting for results.

MedDRA releases: 2024-11 · check-in free text available
2021-10-06
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-10-20
Survey response — day 42, dose 2
MedDRA: Headache, Nasal congestion, Peripheral coldness, Secretion discharge — Feeling: Fair

Free text: Headaches, excessive mucus when I go to sleep, excessive swelling in nasal passages. Face stays cold around forehead, nose and eyes.

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Call 1 — Left Voicemail
2021-12-08
Survey response — 3 months, dose 2
MedDRA: Pulmonary pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain in lungs

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Fatigue, Headache, Peripheral coldness — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe pain in my joints, headache and face is icy cold most of the time. Fatigued.

MedDRA releases: 2024-11 · check-in free text available
2022-09-08
Survey response — 12 months, dose 2
MedDRA: Dyspnoea, Memory impairment, Nodule, Wheezing — Feeling: Poor · Be unable to do your normal daily activities

Free text: Wheezing when I lie down. Knots at the end of my left arm muscles, occasionally knots in my inner thigh veins, forgetfulness and severe almost can't breathe moments with knots around the perimeters of my stomach. No more shots for me.

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-08	Moderna	No
2	2021-09-08	Moderna	No

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 9 — day 0, dose 2

2021-09-08

Systemic reaction (other): No

Release 9 — days 1–6 daily, dose 2

2021-09-10

Systemic reaction (other): For about 2 hours my head ached really badly and my eyes were itchy, blood red and very puffy.

2021-09-11

Systemic reaction (other): Equilibrium is off today. At times I lose balance

2021-09-13

Systemic reaction (other): Constantly feeling excessive nause. Especially when I start to.eat.

Release 10 — day 28, dose 2

2021-10-06

Symptoms: Chills then fever. I went to urgent care center and took COVID test. Waiting for results.

Release 10 — day 42, dose 2

2021-10-20

Symptoms: Headaches, excessive mucus when I go to sleep, excessive swelling in nasal passages. Face stays cold around forehead, nose and eyes.

Release 10 — 3 months, dose 2

2021-12-08

Symptoms: Pain in lungs

Release 11 — 6 months, dose 2

2022-03-11

Symptoms: Severe pain in my joints, headache and face is icy cold most of the time. Fatigued.

Release 12 — 12 months, dose 2

2022-09-08

Symptoms: Wheezing when I lie down. Knots at the end of my left arm muscles, occasionally knots in my inner thigh veins, forgetfulness and severe almost can't breathe moments with knots around the perimeters of my stomach. No more shots for me.

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	Chills	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Memory impairment	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nodule	·	·	✓
SD	Office visit	·	·	✓
SD	Peripheral coldness	·	·	✓
SD	Pulmonary pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test	·	·	✓
SD	Secretion discharge	·	·	✓
SD	Wheezing	·	·	✓
SRO	Balance disorder	·	·	✓
SRO	Eye pruritus	·	·	✓
SRO	Headache	·	·	✓
SRO	Nausea	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Ocular hyperaemia	·	·	✓
SRO	Periorbital swelling	·	·	✓

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