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3LZ-23144-55698

4 vaccinations 3 coded responses 39 check-ins 3 free-text entries 1 call case
Sex
Female
Age at first dose
51-55
ZIP prefix
953 / CA
Registered
2020-12-30
Relationship
Self
Race
Black or African American
Ethnicity
Not Hispanic or Latino
Registered dependents
G22-19482-41161 Adult relative or friend · Male · 2022-04-29
HR7-21334-05785 Child or adolescent in my care · Female · 2022-04-29

Timeline

  1. 2020-12-30
    Registered in v-safe
  2. 2020-12-30
    Dose 1 — Moderna
  3. 2020-12-30
    Survey response — day 0, dose 1
    MedDRA: Condition aggravated, Paraesthesia oral, Pre-existing disease, Somnolence — Feeling: Good · Site: Pain
    Free text: I felt like my allergies were triggered. My lips usually feels tingly when something triggers my allergies, but it did not last long. As for being fatigued or tired, I did get very sleepy, but not sure it was due to the vaccine. I ate after the vaccine and then I had a long drive home in heavy traffic. When I arrived home, I was no longer tired. Just thought I would mentioned it since it did happen after receiving vaccine.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2020-12-31
    Survey response — days 1–6 daily, dose 1
    MedDRA: Pain, Pain in jaw — Feeling: Good · Site: Pain
    Free text: Throbbing pain in left jaw area at the ear. Did not last long. Came & left a few times.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-01-01
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-01-02
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-01-03
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-01-04
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-01-05
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-01-06
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-01-15
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-01-20
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-01-27
    Dose 2 — Moderna
  14. 2021-01-27
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-01-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Redness, Swelling · Headache
    Adult check-in
  16. 2021-01-29
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Redness, Swelling, Itching · None
    Adult check-in
  17. 2021-01-30
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Redness, Swelling · None
    Adult check-in
  18. 2021-01-31
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Redness, Swelling · None
    Adult check-in
  19. 2021-02-01
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-02-02
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-02-03
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  22. 2021-02-10
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-02-17
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-02-24
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-03-03
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-03-11
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-04-28
    Survey response — 3 months, dose 2
    MedDRA: Asthma, Multiple allergies, Pre-existing disease, SARS-CoV-2 test positive — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit
    Free text: Allergies, Asthma flared up, and tested positive for COVID
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  28. 2021-04-28
    Report sent to call center — 3 months, dose 2
    Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  29. 2021-07-28
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  30. 2021-10-08
    Dose 3 — Moderna
  31. 2021-10-23
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  32. 2021-10-31
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  33. 2021-11-06
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  34. 2021-11-12
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  35. 2021-11-20
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  36. 2022-01-07
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  37. 2022-02-10
  38. 2022-02-22
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  39. 2022-04-10
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  40. 2022-04-15
    Dose 4 — Moderna
    Co-administered: Flu
  41. 2022-05-01
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  42. 2022-05-06
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  43. 2022-05-13
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  44. 2022-05-22
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  45. 2022-05-29
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  46. 2022-10-14
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  47. 2023-04-17
    Health check-in — 12 months, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12020-12-30Moderna
22021-01-27Moderna
32021-10-08Moderna No
42022-04-15Moderna Flu

Call center

1 call center case

1 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 1 — day 0, dose 1

2020-12-30

Systemic reaction (other): I felt like my allergies were triggered. My lips usually feels tingly when something triggers my allergies, but it did not last long. As for being fatigued or tired, I did get very sleepy, but not sure it was due to the vaccine. I ate after the vaccine and then I had a long drive home in heavy traffic. When I arrived home, I was no longer tired. Just thought I would mentioned it since it did happen after receiving vaccine.

Release 1 — days 1–6 daily, dose 1

2020-12-31

Systemic reaction (other): Throbbing pain in left jaw area at the ear. Did not last long. Came & left a few times.

Release 8 — 3 months, dose 2

2021-04-28

Symptoms: Allergies, Asthma flared up, and tested positive for COVID

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

FieldPreferred term2021-092023-042024-11
SDAsthma ✓ ✓ ✓
SDMultiple allergies ✓ ✓ ✓
SDPre-existing disease ✓ ✓ ✓
SDSARS-CoV-2 test positive ✓ ✓ ✓
SROCondition aggravated ✓ ✓ ✓
SROFatigue ○ ○ ○
SROImmediate post-injection reaction ○ ○ ○
SROPain ✓ ✓ ✓
SROPain in jaw ✓ ✓ ✓
SROParaesthesia oral ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓
SROSomnolence ✓ ✓ ✓

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

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