4FH-23517-87599

4 vaccinations 10 coded responses 40 check-ins 10 free-text entries 0 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 853 / AZ
Registered: 2021-02-20

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-02-06
Dose 1 — Moderna
2021-02-20
Registered in v-safe
2021-02-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Moderna
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Good · Site: Pain

Free text: Just shot a little sore

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Good

Free text: Occasional dry cough, might be my asthma

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-02
Survey response — day 21, dose 2
MedDRA: Chest discomfort, Cough, Pre-existing disease — Feeling: Fair

Free text: Asthma type tightness in chest and not very productive coughing the previous 3 nights. Probably allergic trigger of asthma, better today and last night. No fever, oxygen level 94 or above

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

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-12
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
2021-10-27
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Ear disorder, Headache, Temporomandibular joint syndrome — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Headache is occasional & prob TMJ/ear

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Fatigue, Injection site pain — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: Arm soreness is less at site, less tired

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site swelling, Pruritus — Feeling: Good · Site: Swelling, Itching

Free text: Had site swelling yesterday&today, slight itch today

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-03
Survey response — day 7, dose 3
MedDRA: Asthma, Cough, Pre-existing disease, Throat clearing — Feeling: Good

Free text: My mild asthma is acting up- clearing throat/coughing occasionally. Albuterol takes care of it.

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-17
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-24
Survey response — day 28, dose 3
MedDRA: Asthma, SARS-CoV-2 test negative — Feeling: Fair

Free text: Mild asthma, tested otc = negative for covid

MedDRA releases: 2024-11 · check-in free text available
2021-12-01
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-28
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-27
Survey response — 6 months, dose 3
MedDRA: Asthma, SARS-CoV-2 test negative — Feeling: Good

Free text: Felt like asthma triggered by dust mite/pollen allergies, runny nose. Took Covid test a couple weeks ago, negative twice in a few days. Took ingle test two days ago, negative.

MedDRA releases: 2024-11 · check-in free text available
2022-05-07
Dose 4 — Moderna
2022-05-15
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-28
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-04
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-11
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-18
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-06
Survey response — 3 months, dose 4
MedDRA: Chest discomfort — Feeling: Fair

Free text: Tightness in lungs; think it's paint fumes outside apartment

MedDRA releases: 2024-11 · check-in free text available
2022-11-05
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-05-10
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-06	Moderna
2	2021-03-12	Moderna
3	2021-10-27	Moderna	No
4	2022-05-07	Moderna	No

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-15

Systemic reaction (other): Just shot a little sore

2021-03-16

Systemic reaction (other): Occasional dry cough, might be my asthma

Release 6 — day 21, dose 2

2021-04-02

Symptoms: Asthma type tightness in chest and not very productive coughing the previous 3 nights. Probably allergic trigger of asthma, better today and last night. No fever, oxygen level 94 or above

Release 10 — days 1–6 daily, dose 3

2021-10-28

Systemic reaction (other): Headache is occasional & prob TMJ/ear

2021-10-29

Systemic reaction (other): Arm soreness is less at site, less tired

2021-10-30

Systemic reaction (other): Had site swelling yesterday&today, slight itch today

Release 10 — day 7, dose 3

2021-11-03

Systemic reaction (other): My mild asthma is acting up- clearing throat/coughing occasionally. Albuterol takes care of it.

Release 10 — day 28, dose 3

2021-11-24

Symptoms: Mild asthma, tested otc = negative for covid

Release 11 — 6 months, dose 3

2022-04-27

Symptoms: Felt like asthma triggered by dust mite/pollen allergies, runny nose. Took Covid test a couple weeks ago, negative twice in a few days. Took ingle test two days ago, negative.

Release 12 — 3 months, dose 4

2022-08-06

Symptoms: Tightness in lungs; think it's paint fumes outside apartment

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	Asthma	·	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SRO	Asthma	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Ear disorder	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Headache	·	·	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site swelling	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Pruritus	·	·	✓
SRO	Temporomandibular joint syndrome	·	·	✓
SRO	Throat clearing	·	·	✓

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