3NG-23883-00134

2 vaccinations 10 coded responses 26 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 971 / OR
Registered: 2021-01-19

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

2021-01-19
Registered in v-safe
2021-01-19
Dose 1 — Moderna
2021-01-19
Health check-in — day 0, dose 1
Feeling: Fair · Muscle or body aches

Adult check-in
2021-01-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Disturbance in attention, Dizziness — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Fatigue or tiredness, Nausea

Free text: Dizziness, lack of mental focus, shivering but not chilled

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-24
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Headache, Fatigue or tiredness

Free text: Slight dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-01-26
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Survey response — day 14, dose 1
MedDRA: Burning sensation, Chest X-ray, Chest pain, Dissociation, Disturbance in attention, Electrocardiogram, Heart rate increased, Hypertension, Laboratory test, Paraesthesia, Skin burning sensation, Tremor, Unevaluable event — Feeling: Poor · Be unable to work, 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: Symptoms: Uncontrollable shaking/tremors, high heart rate lasting days, high blood pressure, severe pins and needles in my hands, feet and scalp, intermittent burning sensation over my face, chest, upper back and arms, occasional lack of mental focus, disassoc · Healthcare visit (other): Lab tests, ecg, chest xray

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Report sent to call center — day 14, dose 1
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)
2021-02-09
Survey response — day 21, dose 1
MedDRA: Diarrhoea, Dizziness, Fatigue, Nausea — 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, Outpatient clinic or urgent care clinic visit

Free text: Nausea, wooziness, and extreme fatigue became worse for a few days after last check in. Also had diarrhea for a few days, I have been feeling back to normal ( pre vaccine) for about 3 days now. Total days of symptoms= 18 days from vaccination date

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Report sent to call center — day 21, dose 1
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)
2021-02-16
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Syncope — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Passing out

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Pain — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Random sudden stabbing pains similar to side stiches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Burning sensation, Decreased appetite, Pruritus, Visual impairment — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: General itchiness, low/ no appetite, visual over stimulation, burning sensation in my chest

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-02-26
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-19
Survey response — day 28, dose 2
MedDRA: Chills, Tremor, Vertigo — Feeling: Good · Be unable to do your normal daily activities

Free text: Uncontrollable shaking/ rigors , vertigo

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-02
Survey response — day 42, dose 2
MedDRA: Bacterial vaginosis, Bacterial vulvovaginitis, Fungal infection, Headache, Urinary tract infection — Feeling: Good · Be unable to do your normal daily activities

Free text: Headaches, Possible bladder/ uti infection, vaginosis or yeast infection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-21
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-06-17
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-08-22
Health check-in — 6 months, dose 2
Feeling: Fair

Adult check-in
2022-02-19
Survey response — 12 months, dose 2
MedDRA: Arthralgia, Dyspepsia, Fatigue, Nausea, Neck pain, Pain in extremity, Paraesthesia, Skin burning sensation — Feeling: Fair · Be unable to do your normal daily activities

Free text: Neck and shoulder pain, chronic nausea, frequent heartburn, burning/ tingling under my skin particularly upper back, pain in the backs of my thighs, exhausted

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-19	Moderna

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-21

Systemic reaction (other): Dizziness, lack of mental focus, shivering but not chilled

2021-01-24

Systemic reaction (other): Slight dizziness

Release 3 — day 14, dose 1

2021-02-02

Symptoms: Uncontrollable shaking/tremors, high heart rate lasting days, high blood pressure, severe pins and needles in my hands, feet and scalp, intermittent burning sensation over my face, chest, upper back and arms, occasional lack of mental focus, disassoc cut off by CDC

Healthcare visit (other): Lab tests, ecg, chest xray

Release 3 — day 21, dose 1

2021-02-09

Symptoms: Nausea, wooziness, and extreme fatigue became worse for a few days after last check in. Also had diarrhea for a few days, I have been feeling back to normal ( pre vaccine) for about 3 days now. Total days of symptoms= 18 days from vaccination date

Release 4 — days 1–6 daily, dose 2

2021-02-20

Systemic reaction (other): Passing out

2021-02-21

Systemic reaction (other): Random sudden stabbing pains similar to side stiches

2021-02-22

Systemic reaction (other): General itchiness, low/ no appetite, visual over stimulation, burning sensation in my chest

Release 5 — day 28, dose 2

2021-03-19

Symptoms: Uncontrollable shaking/ rigors , vertigo

Release 6 — day 42, dose 2

2021-04-02

Symptoms: Headaches, Possible bladder/ uti infection, vaginosis or yeast infection

Release 11 — 12 months, dose 2

2022-02-19

Symptoms: Neck and shoulder pain, chronic nausea, frequent heartburn, burning/ tingling under my skin particularly upper back, pain in the backs of my thighs, exhausted

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	Chest X-ray	○	✓	○
HCVO	Electrocardiogram	○	✓	○
HCVO	Laboratory test	○	✓	○
HCVO	Unevaluable event	✓	·	✓
SD	Arthralgia	·	·	✓
SD	Bacterial vaginosis	✓	·	✓
SD	Bacterial vulvovaginitis	○	✓	○
SD	Burning sensation	✓	✓	✓
SD	Chest pain	✓	·	✓
SD	Chills	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dissociation	✓	·	✓
SD	Disturbance in attention	✓	✓	✓
SD	Dizziness	✓	✓	✓
SD	Dyspepsia	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Fungal infection	✓	·	✓
SD	Headache	✓	✓	✓
SD	Heart rate increased	✓	✓	✓
SD	Hypertension	✓	·	✓
SD	Nausea	✓	✓	✓
SD	Neck pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Paraesthesia	✓	✓	✓
SD	Skin burning sensation	✓	·	✓
SD	Tremor	✓	✓	✓
SD	Urinary tract infection	✓	✓	✓
SD	Vertigo	✓	✓	✓
SRO	Burning sensation	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Disturbance in attention	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Syncope	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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