4EX-10165-98562

2 vaccinations 6 coded responses 21 check-ins 6 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 210 / MD
Registered: 2021-01-05

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

2020-12-30
Dose 1 — Moderna
2021-01-05
Registered in v-safe
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Diarrhea

Adult check-in
2021-01-06
Health check-in — day 7, dose 1
Feeling: Fair · Fever · Headache, Fatigue or tiredness · Be unable to work

Adult check-in
2021-01-06
Report sent to call center — day 7, dose 1
Be unable to work

1 call case(s)
2021-01-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-22
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-01-27
Survey response — day 28, dose 1
MedDRA: Nasal congestion, Nasopharyngitis, Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: I was diagnosed with cold Sx sore throat and stuffinessCovid neg

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-03
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-02-10
Dose 2 — Moderna
2021-02-10
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Gingival pain, Gingival swelling — Feeling: Fair · Site: Pain, Redness, Itching · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Gums swollen for last 2 days and sore

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 2
MedDRA: Gingival pain, Gingival swelling — Feeling: Fair · Site: Redness, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Gums swollen and sensitive to food and fluids Painful

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Gingival pain, Lymphadenopathy, Mammogram abnormal — Feeling: Fair · Site: Itching · Joint pains · Be unable to do your normal daily activities

Free text: Gums still sore in mouth, slightly improved Had mammogram and had increased in size, ? Due to lympaphadenopathy from Covid vaccine. Also having a lot of bilateral hip pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 7, dose 2
MedDRA: Arthralgia, Gingival discomfort, Lip pain — Feeling: Fair · Joint pains, Diarrhea

Free text: Food has seemed to go right through. Gum discomfort and inner lip pin has continued. Hip pain better but remains

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Health check-in — day 14, dose 2
Feeling: Good

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

Adult check-in
2021-03-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-17
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-12
Call 1 — Left Voicemail
2021-05-12
Survey response — 3 months, dose 2
MedDRA: Brain fog, Pain, Sluggishness — Feeling: Fair

Free text: Body aches and sluggishness occasionally foggy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Moderna
2	2021-02-10	Moderna

Call center

2 call center cases

1 unsuccessful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 2 — day 28, dose 1

2021-01-27

Symptoms: I was diagnosed with cold Sx sore throat and stuffinessCovid neg

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Gums swollen for last 2 days and sore

2021-02-15

Systemic reaction (other): Gums swollen and sensitive to food and fluids Painful

2021-02-16

Systemic reaction (other): Gums still sore in mouth, slightly improved Had mammogram and had increased in size, ? Due to lympaphadenopathy from Covid vaccine. Also having a lot of bilateral hip pain

Release 4 — day 7, dose 2

2021-02-17

Systemic reaction (other): Food has seemed to go right through. Gum discomfort and inner lip pin has continued. Hip pain better but remains

Release 8 — 3 months, dose 2

2021-05-12

Symptoms: Body aches and sluggishness occasionally foggy

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	Brain fog	✓	✓	✓
SD	Nasal congestion	✓	✓	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sluggishness	✓	✓	✓
SRO	Arthralgia	✓	✓	✓
SRO	Gingival discomfort	✓	✓	✓
SRO	Gingival pain	✓	✓	✓
SRO	Gingival swelling	✓	✓	✓
SRO	Lip pain	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Mammogram abnormal	✓	✓	✓

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