3VS-26548-73827

4 vaccinations 11 coded responses 32 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 445 / OH
Registered: 2021-01-07

Relationship: Self
Race: Multiracial
Ethnicity: Hispanic or Latino

Timeline

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

2021-01-07
Registered in v-safe
2021-01-07
Dose 1 — Moderna
2021-01-07
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Joint swelling — Feeling: Good

Free text: Slight headache every day and ankles had a slight swollen after I got home from work last night.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-12
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Joint swelling — Feeling: Good

Free text: The headaches that I mentioned on the seventh eighth and ninth we're all mild lasting hour and a half and the swelling on my right ankle slightly swollen no other health conditions or symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-28
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-03
Dose 2 — Moderna
2021-02-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-26
Survey response — day 21, dose 2
MedDRA: Back pain, Limb discomfort, Musculoskeletal pain, Pain in extremity — Feeling: Fair

Free text: My lower back hurting and aching, both sides of my middle shoulder blades on my back aching and some discomfort and pain on the injection arm the left side arm

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

Adult check-in
2021-03-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-17
Survey response — day 42, dose 2
MedDRA: Bone pain, Fatigue — Feeling: Fair

Free text: Real fatigue, and bones ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Survey response — 3 months, dose 2
MedDRA: Injected limb mobility decreased, Injection site pain — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: April 12, 2021, My Left arm and shoulder shot area I could not move was very sore painful its just starting which today is May 5 just getting better I dont know if its related but I figure Ill tell you in case other people had the same i

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-04
Survey response — 6 months, dose 2
MedDRA: Muscle rupture, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I dont know if this makes a difference but the left arm where the shot was that I had a complete tear of a muscle it might not be anything with the shot but I figure to let you know in case other people have complained or had same issue little tin · Healthcare visit (other): My doctor

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-04
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-22
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-21
Dose 3 — Moderna
2022-02-05
Survey response — 12 months, dose 2
MedDRA: Cystitis, Haematological infection, Hospitalisation, Sepsis — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: I was septic, bladder Infection that went into my blood hospitalized for 8 days.

MedDRA releases: 2024-11 · check-in free text available
2022-02-05
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2022-02-07
Call 1 — Left Voicemail
2022-05-06
Dose 4 — Moderna
2022-05-06
Survey response — day 0, dose 4
MedDRA: Unevaluable event — Feeling: Good

Free text: As of 2:10pm just got the shot today Friday 5-6-22

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Survey response — days 1–6 daily, dose 4
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Tenderness pain in the shot area

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Survey response — days 1–6 daily, dose 4
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Pain where the shot given was just tender to touch not really painful but you don't give that as symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-05-09
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-10
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · None

Adult check-in
2022-05-11
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-13
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-20
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-10
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-17
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-07
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-11-04
Survey response — 6 months, dose 4
MedDRA: Influenza — Feeling: Good · Be unable to work or attend school

Free text: Flue

MedDRA releases: 2024-11 · check-in free text available
2023-05-06
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-03	Moderna
3	2021-12-21	Moderna	No
4	2022-05-06	Moderna	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-09

Systemic reaction (other): Slight headache every day and ankles had a slight swollen after I got home from work last night.

2021-01-12

Systemic reaction (other): The headaches that I mentioned on the seventh eighth and ninth we're all mild lasting hour and a half and the swelling on my right ankle slightly swollen no other health conditions or symptoms

Release 4 — day 21, dose 2

2021-02-26

Symptoms: My lower back hurting and aching, both sides of my middle shoulder blades on my back aching and some discomfort and pain on the injection arm the left side arm

Release 5 — day 42, dose 2

2021-03-17

Symptoms: Real fatigue, and bones ache

Release 8 — 3 months, dose 2

2021-05-05

Symptoms: April 12, 2021, My Left arm and shoulder shot area I could not move was very sore painful its just starting which today is May 5 just getting better I dont know if its related but I figure Ill tell you in case other people had the same i

Release 9 — 6 months, dose 2

2021-08-04

Symptoms: I dont know if this makes a difference but the left arm where the shot was that I had a complete tear of a muscle it might not be anything with the shot but I figure to let you know in case other people have complained or had same issue little tin

Healthcare visit (other): My doctor

Release 11 — 12 months, dose 2

2022-02-05

Symptoms: I was septic, bladder Infection that went into my blood hospitalized for 8 days.

Release 11 — day 0, dose 4

2022-05-06

Systemic reaction (other): As of 2:10pm just got the shot today Friday 5-6-22

Release 11 — days 1–6 daily, dose 4

2022-05-07

Systemic reaction (other): Tenderness pain in the shot area

2022-05-08

Systemic reaction (other): Pain where the shot given was just tender to touch not really painful but you don't give that as symptoms

Release 12 — 6 months, dose 4

2022-11-04

Symptoms: Flue

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	Office visit	✓	·	✓
SD	Back pain	✓	✓	✓
SD	Bone pain	✓	✓	✓
SD	Cystitis	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Haematological infection	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Influenza	·	·	✓
SD	Injected limb mobility decreased	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Limb discomfort	✓	✓	✓
SD	Muscle rupture	✓	·	✓
SD	Musculoskeletal pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Sepsis	·	·	✓
SRO	Headache	✓	✓	✓
SRO	Injection site pain	·	·	✓
SRO	Joint swelling	✓	✓	✓
SRO	Unevaluable event	·	·	✓

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