3JE-15195-39100 · OpenVSafe

Timeline

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

2021-02-24
Dose 1 — Moderna
2021-03-24
Dose 2 — Moderna
2021-11-03
Registered in v-safe
2021-11-05
Dose 3 — Moderna
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Body temperature increased, Self-medication — Feeling: Fair · Site: Pain · Headache · Be unable to do your normal daily activities

Free text: Low grade fever last night 99.4 took two Tylenol.

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Survey response — days 1–6 daily, dose 3
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: All is good. Walked 4 miles today. Just arm is still sore.

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Survey response — days 1–6 daily, dose 3
MedDRA: Headache — Feeling: Good · Site: Itching · Headache

Free text: Although I don't get a headache very often I don't know if the one I had today is related to shot??

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: Headache — Feeling: Fair · Headache

Free text: Headache again today don't know if it's related to shot?

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-19
Survey response — day 14, dose 3
MedDRA: Chills, Diarrhoea, Pyrexia, Self-medication, Tremor — Feeling: Good · Be unable to do your normal daily activities

Free text: Had senior flu shot on Tuesday at 11:30am by 4:30 had shivers and uncontrollable shaking. Took two Tylenol and slept from 4:30 to 9am the next morning. Fever on Wednesday again Thursday no fever but had diarrhea. Today Friday I feel fine.

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-24	Moderna	No
2	2021-03-24	Moderna	No
3	2021-11-05	Moderna	No

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-07

Systemic reaction (other): Low grade fever last night 99.4 took two Tylenol.

2021-11-08

Systemic reaction (other): All is good. Walked 4 miles today. Just arm is still sore.

2021-11-09

Systemic reaction (other): Although I don't get a headache very often I don't know if the one I had today is related to shot??

2021-11-11

Systemic reaction (other): Headache again today don't know if it's related to shot?

Release 10 — day 14, dose 3

2021-11-19

Symptoms: Had senior flu shot on Tuesday at 11:30am by 4:30 had shivers and uncontrollable shaking. Took two Tylenol and slept from 4:30 to 9am the next morning. Fever on Wednesday again Thursday no fever but had diarrhea. Today Friday I feel fine.

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	Chills	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Pyrexia	·	·	✓
SD	Self-medication	·	·	✓
SD	Tremor	·	·	✓
SRO	Body temperature increased	·	·	✓
SRO	Headache	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Self-medication	·	·	✓

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