3KL-22872-07926

5 vaccinations 9 coded responses 41 check-ins 9 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 109 / NY
Registered: 2021-03-21

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

2021-03-20
Dose 1 — Moderna
2021-03-21
Registered in v-safe
2021-03-21
Survey response — days 1–6 daily, dose 1
MedDRA: Limb discomfort — Feeling: Good · Fatigue or tiredness

Free text: Just a sore arm, no pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain — Feeling: Good · Fatigue or tiredness

Free text: Very mild injection site soreness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

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

Adult check-in
2021-03-27
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-03
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-10
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-17
Dose 2 — Moderna
2021-04-17
Health check-in — day 0, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Pre-existing disease — Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Have IBS

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Irritable bowel syndrome, Pre-existing disease — Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Hx of IBS

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — day 7, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-05-01
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-15
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-22
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-29
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-17
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-16
Survey response — 6 months, dose 2
MedDRA: Blood pressure increased — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: BP has been elevated. Started on Metoprolol Succ ER 25 mg, one tab daily.

MedDRA releases: 2024-11 · check-in free text available
2021-10-16
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-20
Call 1 — Left Voicemail
2021-11-09
Dose 3 — Moderna
2022-04-18
Survey response — 12 months, dose 2
MedDRA: Hypertension, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: On medication for hypertension · Healthcare visit (other): Saw cardiologist

MedDRA releases: 2024-11 · check-in free text available
2022-04-18
Report sent to call center — 12 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-19
Call 1 — Left Voicemail
2022-05-10
Survey response — 6 months, dose 3
MedDRA: Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Hypertension, on metoprolol succ ER 25mg oral daily. Just started amlodipine 5mg oral daily in addition. Not related to vaccine, BP started elevating prior to vaccines. · Healthcare visit (other): See cardiologist who follows me in addition to my primary care provider.

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-11
Call 1 — Left Voicemail
2022-05-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-11
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-14
Dose 4 — Moderna
2022-10-13
Dose 5 — Moderna
2022-10-13
Health check-in — day 0, dose 5
Feeling: Good · Muscle or body aches

Adult check-in
2022-10-14
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-15
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-16
Survey response — days 1–6 daily, dose 5
MedDRA: Abdominal pain, Pre-existing disease — Feeling: Fair · Fatigue or tiredness, Abdominal pain

Free text: Have history of IBS, abdominal pain due to that.

MedDRA releases: 2024-11 · check-in free text available
2022-10-17
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2022-10-18
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-19
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-20
Health check-in — day 7, dose 5
Feeling: Good · None

Adult check-in
2022-10-27
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-11-03
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-10
Survey response — day 28, dose 5
MedDRA: Incisional hernia repair — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Had an incisional hernia repair on November 7th, 2022 · Healthcare visit (other): Had incisional hernia repair.

MedDRA releases: 2024-11 · check-in free text available
2022-11-10
Report sent to call center — day 28, dose 5
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-11-11
Call 1 — Left Voicemail
2022-11-17
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-24
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-12
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-04-13
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-20	Moderna
2	2021-04-17	Moderna
3	2021-11-09	Moderna	No
4	2022-07-14	Moderna	No
5	2022-10-13	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-21

Systemic reaction (other): Just a sore arm, no pain

2021-03-22

Systemic reaction (other): Very mild injection site soreness

Release 7 — days 1–6 daily, dose 2

2021-04-20

Systemic reaction (other): Have IBS

2021-04-23

Systemic reaction (other): Hx of IBS

Release 10 — 6 months, dose 2

2021-10-16

Symptoms: BP has been elevated. Started on Metoprolol Succ ER 25 mg, one tab daily.

Release 11 — 12 months, dose 2

2022-04-18

Symptoms: On medication for hypertension

Healthcare visit (other): Saw cardiologist

Release 11 — 6 months, dose 3

2022-05-10

Symptoms: Hypertension, on metoprolol succ ER 25mg oral daily. Just started amlodipine 5mg oral daily in addition. Not related to vaccine, BP started elevating prior to vaccines.

Healthcare visit (other): See cardiologist who follows me in addition to my primary care provider.

Release 12 — days 1–6 daily, dose 5

2022-10-16

Systemic reaction (other): Have history of IBS, abdominal pain due to that.

Release 12 — day 28, dose 5

2022-11-10

Symptoms: Had an incisional hernia repair on November 7th, 2022

Healthcare visit (other): Had incisional hernia repair.

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	Incisional hernia repair	·	·	✓
HCVO	Office visit	·	·	✓
SD	Blood pressure increased	·	·	✓
SD	Hypertension	·	·	✓
SD	Incisional hernia repair	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Abdominal pain	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Irritable bowel syndrome	✓	✓	○
SRO	Limb discomfort	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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