3YU-22652-05234

3 vaccinations 7 coded responses 27 check-ins 7 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 601 / IL
Registered: 2021-01-21

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

2021-01-21
Registered in v-safe
2021-01-21
Dose 1 — Moderna
2021-01-21
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-23
Survey response — days 1–6 daily, dose 1
MedDRA: Discomfort, Sleep disorder — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Discomfort disrupted sleep

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-28
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-11
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-18
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-27
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-08-22
Survey response — 6 months, dose 2
MedDRA: Type 2 diabetes mellitus — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Type II Diabetes

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-22
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-28
Dose 3 — Moderna
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Site: Pain · Headache

Free text: Enlarged, tender lymph node in Right supraclavicular region -- vaccination was received in Right arm.

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Site: Pain · Joint pains

Free text: (Right Supraclavicular) enlarged, tender lymph node persists. (Booster shot was given in Right deltoid)

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Site: Pain · Joint pains

Free text: Enlarged, tender, Right supraclavicular lymph node persists. Booster was given in Right deltoid.

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Survey response — day 7, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good

Free text: Right supraclavicular lymph node no longer tender, and seems to be decreasing in size. (Booster given in Right Deltoid)

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-18
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-09
Survey response — day 42, dose 3
MedDRA: Abdominal pain upper, Diarrhoea, Gastrointestinal pain, Gastrointestinal tract irritation, Nausea — Feeling: Fair

Free text: GI iritability (stomach & intestinal cramping, diarrhea, and mild nausea past 4-5 days). Likely an unrelated flu virus?

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-29
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-29
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna
2	2021-02-19	Moderna
3	2021-10-28	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-23

Systemic reaction (other): Discomfort disrupted sleep

Release 9 — 6 months, dose 2

2021-08-22

Symptoms: Type II Diabetes

Release 10 — days 1–6 daily, dose 3

2021-10-31

Systemic reaction (other): Enlarged, tender lymph node in Right supraclavicular region -- vaccination was received in Right arm.

2021-11-01

Systemic reaction (other): (Right Supraclavicular) enlarged, tender lymph node persists. (Booster shot was given in Right deltoid)

2021-11-02

Systemic reaction (other): Enlarged, tender, Right supraclavicular lymph node persists. Booster was given in Right deltoid.

Release 10 — day 7, dose 3

2021-11-04

Systemic reaction (other): Right supraclavicular lymph node no longer tender, and seems to be decreasing in size. (Booster given in Right Deltoid)

Release 10 — day 42, dose 3

2021-12-09

Symptoms: GI iritability (stomach & intestinal cramping, diarrhea, and mild nausea past 4-5 days). Likely an unrelated flu virus?

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	Abdominal pain upper	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Gastrointestinal pain	·	·	✓
SD	Gastrointestinal tract irritation	·	·	✓
SD	Nausea	·	·	✓
SD	Type 2 diabetes mellitus	✓	·	✓
SRO	Discomfort	✓	✓	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Sleep disorder	✓	✓	✓

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