3HY-24361-09430

5 vaccinations 7 coded responses 42 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 809 / CO
Registered: 2021-02-20

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

2021-02-20
Registered in v-safe
2021-02-20
Dose 1 — Moderna
2021-02-20
Survey response — day 0, dose 1
MedDRA: Anxiety, Asthma — Feeling: Good · Site: Pain · Headache

Free text: Felt like I do when I get exercise induced asthma. Most likely set off by anxiety. Used my inhaler and was fine. This occurred soon after my shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2021-02-22
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, SARS-CoV-2 test — Feeling: Fair · Site: Pain · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Cough · Healthcare visit (other): Had a covid test.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-20
Dose 2 — Moderna
2021-03-20
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-23
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Axillary pain — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Free text: Pain in arm pit and shoulder, much better today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-27
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-19
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-16
Call 1 — Left Voicemail
2021-08-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-09-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-02
Dose 3 — Moderna
2022-03-20
Survey response — 12 months, dose 2
MedDRA: Chest discomfort, Nasal congestion, Pre-existing disease, Retinal vascular occlusion, Vertigo — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Branch retinal occlusion. Vertigo Nasal congeatiin and tight chest. Allergies

MedDRA releases: 2024-11 · check-in free text available
2022-03-20
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-22
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-19
Dose 4 — Moderna
2022-05-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2022-05-26
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-06-02
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-09
Survey response — day 21, dose 4
MedDRA: Cough, Sinus congestion — Feeling: Fair

Free text: Sinus congestion and tight cough that has become loose. No fever or fatigue. My grandkids all had runny noses the weekend they stayed with me.

MedDRA releases: 2024-11 · check-in free text available
2022-06-16
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-30
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-19
Survey response — 3 months, dose 4
MedDRA: Cough, Nasopharyngitis, Oropharyngeal pain, Respiratory tract congestion — Feeling: Good · Be unable to do your normal daily activities

Free text: Caught a cold twice about two months apart. Both involved bad coughs, one preceded by a sore throat and tons if congestion. Faild to take a civid test fir both but recovered quickly.

MedDRA releases: 2024-11 · check-in free text available
2022-10-03
Dose 5 — Moderna
Co-administered: Flu
2022-10-12
Health check-in — day 7, dose 5
Feeling: Good · Site: Pain · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2022-10-17
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-25
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-31
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-08
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-14
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-02
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-03
Survey response — 6 months, dose 5
MedDRA: Ear infection, Oropharyngeal pain, Rhinorrhoea, Sinusitis, Tympanic membrane perforation, Upper-airway cough syndrome — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-03
Report sent to call center — 6 months, dose 5
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-04
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-20	Moderna
2	2021-03-20	Moderna
3	2021-11-02	Moderna	No
4	2022-05-19	Moderna	No
5	2022-10-03	Moderna	Flu

Call center

3 call center cases

3 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — day 0, dose 1

2021-02-20

Systemic reaction (other): Felt like I do when I get exercise induced asthma. Most likely set off by anxiety. Used my inhaler and was fine. This occurred soon after my shot.

Release 4 — days 1–6 daily, dose 1

2021-02-22

Systemic reaction (other): Cough

Healthcare visit (other): Had a covid test.

Release 6 — days 1–6 daily, dose 2

2021-03-23

Systemic reaction (other): Pain in arm pit and shoulder, much better today

Release 11 — 12 months, dose 2

2022-03-20

Symptoms: Branch retinal occlusion. Vertigo Nasal congeatiin and tight chest. Allergies

Release 12 — day 21, dose 4

2022-06-09

Symptoms: Sinus congestion and tight cough that has become loose. No fever or fatigue. My grandkids all had runny noses the weekend they stayed with me.

Release 12 — 3 months, dose 4

2022-08-19

Symptoms: Caught a cold twice about two months apart. Both involved bad coughs, one preceded by a sore throat and tons if congestion. Faild to take a civid test fir both but recovered quickly.

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	SARS-CoV-2 test	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	Cough	·	·	✓
SD	Ear infection	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Retinal vascular occlusion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sinusitis	·	·	✓
SD	Tympanic membrane perforation	·	·	✓
SD	Upper-airway cough syndrome	·	·	✓
SD	Vertigo	·	·	✓
SRO	Anxiety	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Asthma	✓	✓	✓
SRO	Axillary pain	✓	✓	✓
SRO	Cough	✓	✓	✓

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