4FA-19796-49102

3 vaccinations 10 coded responses 23 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 403 / KY
Registered: 2021-04-17

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-03-13
Dose 1 — Moderna
2021-04-15
Dose 2 — Moderna
2021-04-17
Registered in v-safe
2021-04-19
Survey response — days 1–6 daily, dose 2
MedDRA: Confusional state, Hallucination, Insomnia — Feeling: Fair · Site: Pain, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Mental confusion, misspelling words, hallucinations, insomnia

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Survey response — days 1–6 daily, dose 2
MedDRA: Confusional state, Cough, Dyspnoea, Ear discomfort, Feeling abnormal, Musculoskeletal stiffness — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Cough, shortness of breath with activities, congestion, fullness in my left ear, insomina, neck stiffness mental confusion jumbled thoughts, and seeing things that are not there

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-21
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Dyspnoea, Musculoskeletal stiffness, Nightmare — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Shortness of breathe with activities, Neck stiffness, daytime nightmares, cough, increased iron supplement per pcp

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Survey response — day 7, dose 2
MedDRA: Ageusia, Anosmia, Cough, Fatigue, Respiratory tract congestion, Vision blurred — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Cough, congestion, windedness, blurred vision. Sense of SMELL returning somewhat (pungent odors only: skunk, deer pee, gasoline vapors but can't smell bleach or pine-sol) after lost of it in Jan 2021 following COVID infection. Still cannot taste..

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-13
Survey response — day 28, dose 2
MedDRA: Ageusia, Asthenia, Cough, Fatigue, Insomnia — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Very low energy. Insomina, tiredness and dry cough have returned. Still unable to taste. No fever.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Survey response — day 35, dose 2
MedDRA: Brain fog, Chest discomfort, Fatigue, Loss of personal independence in daily activities, Memory impairment — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Extreme fatigue, brain fog and forgetfulness, chest tightness with simple activities, like, climbing stairs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-20
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-29
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-15
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-01
Dose 3 — Moderna
2021-11-01
Health check-in — day 0, dose 3
Feeling: Poor · Site: Pain, Redness · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Dyspnoea — Feeling: Poor · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Difficulty taking deep breathes, cough

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Chills, Muscle or body aches

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-09
Health check-in — day 7, dose 3
Feeling: Good · Chills, Headache, Joint pains, Muscle or body aches

Adult check-in
2021-11-15
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-01
Survey response — day 28, dose 3
MedDRA: Cough, Dyspnoea — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: shortness of breathe and coughing

MedDRA releases: 2024-11 · check-in free text available
2021-12-15
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-31
Survey response — 3 months, dose 3
MedDRA: Respiratory tract congestion, Wheezing — Feeling: Fair

Free text: Weezing, chest congestion

MedDRA releases: 2024-11 · check-in free text available
2022-04-28
Call 1 — Left Voicemail
2022-05-02
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-02
Survey response — 12 months, dose 3
MedDRA: Body temperature increased, Chills, Cough, Decreased appetite, Fatigue, Headache, Insomnia, Intermenstrual bleeding, Pain, Respiratory tract congestion — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Body aches, fatigued, cough, congestion, insomnia, break through bleeding, chills, elevated temperature, headache, loss of appetite

MedDRA releases: 2024-11 · check-in free text available
2022-11-02
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-11-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-13	Moderna
2	2021-04-15	Moderna
3	2021-11-01	Moderna	No

Call center

2 call center cases

2 successful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-19

Systemic reaction (other): Mental confusion, misspelling words, hallucinations, insomnia

2021-04-20

Systemic reaction (other): Cough, shortness of breath with activities, congestion, fullness in my left ear, insomina, neck stiffness mental confusion jumbled thoughts, and seeing things that are not there

2021-04-21

Systemic reaction (other): Shortness of breathe with activities, Neck stiffness, daytime nightmares, cough, increased iron supplement per pcp

Release 7 — day 7, dose 2

2021-04-22

Systemic reaction (other): Cough, congestion, windedness, blurred vision. Sense of SMELL returning somewhat (pungent odors only: skunk, deer pee, gasoline vapors but can't smell bleach or pine-sol) after lost of it in Jan 2021 following COVID infection. Still cannot taste..

Release 8 — day 28, dose 2

2021-05-13

Symptoms: Very low energy. Insomina, tiredness and dry cough have returned. Still unable to taste. No fever.

Release 8 — day 35, dose 2

2021-05-20

Symptoms: Extreme fatigue, brain fog and forgetfulness, chest tightness with simple activities, like, climbing stairs.

Release 10 — days 1–6 daily, dose 3

2021-11-02

Systemic reaction (other): Difficulty taking deep breathes, cough

Release 10 — day 28, dose 3

2021-12-01

Symptoms: shortness of breathe and coughing

Release 11 — 3 months, dose 3

2022-01-31

Symptoms: Weezing, chest congestion

Release 12 — 12 months, dose 3

2022-11-02

Symptoms: Body aches, fatigued, cough, congestion, insomnia, break through bleeding, chills, elevated temperature, headache, loss of appetite

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	Ageusia	✓	✓	✓
SD	Asthenia	✓	✓	✓
SD	Body temperature increased	·	·	✓
SD	Brain fog	✓	✓	✓
SD	Chest discomfort	✓	✓	✓
SD	Chills	·	·	✓
SD	Cough	✓	✓	✓
SD	Decreased appetite	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Insomnia	✓	✓	✓
SD	Intermenstrual bleeding	·	·	✓
SD	Loss of personal independence in daily activities	✓	✓	✓
SD	Memory impairment	✓	✓	✓
SD	Pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Wheezing	·	·	✓
SRO	Ageusia	✓	✓	✓
SRO	Anosmia	✓	✓	✓
SRO	Confusional state	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Ear discomfort	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Hallucination	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Musculoskeletal stiffness	✓	✓	✓
SRO	Nightmare	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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