4JH-99241-61014

3 vaccinations 11 coded responses 33 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 794 / TX
Registered: 2021-01-12

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

2021-01-12
Registered in v-safe
2021-01-12
Dose 1 — Moderna
2021-01-12
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-20
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-02-11
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fever · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-12
Survey response — day 28, dose 2
MedDRA: Urinary tract infection — Feeling: Fair

Free text: May have UTI-see dr Monday.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-14
Survey response — 3 months, dose 2
MedDRA: Nephrolithiasis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Kidney stones

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-27
Dose 3 — Moderna
Co-administered: Shingles
2021-10-27
Survey response — day 0, dose 3
MedDRA: Pain in extremity — Feeling: Good

Free text: Shindrix shot arm very sore

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Headache — Feeling: Fair · Site: Pain

Free text: Headache but pretty sure it is Shindrix since it is causing more pain.

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Pain — Feeling: Good

Free text: Still sore with Shindrix but better

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: Adverse reaction — Feeling: Good · Headache

Free text: Pretty sure it was still due to Shindrix

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Office visit, Urinary tract infection — Feeling: Fair · Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Went to dr- have a UTI

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Report sent to call center — days 1–6 daily, dose 3
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Urinary tract infection — Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Due to UTI I am sure-not either vaccines

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Call 1 — Left Voicemail
2021-11-03
Survey response — day 7, dose 3
MedDRA: Urinary tract infection — Feeling: Fair · Headache

Free text: Still dealing with UTI

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Call 2 — Requested Callback
2021-11-05
Callback requested for
04:30PM ET
2021-11-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2021-11-05
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-11
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
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
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
2022-01-26
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-27
Survey response — 6 months, dose 3
MedDRA: Injection site reaction, Pain in extremity, Rash erythematous, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Had 2nd shingle shot & arm very sore & large area has a red rash about 4" below injection site. Will check with dr tomorrow · Healthcare visit (other): Not sure yet

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-28
Call 1 — Left Voicemail
2022-10-27
Survey response — 12 months, dose 3
MedDRA: Fall, Localised infection, Nervous system disorder, Urinary tract infection — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Have had UTI's & fell outside & my left big toe has gotten infected so taking antibiotics & cream. Also having nerve problems & will have neck surgery in 2 months.

MedDRA releases: 2024-11 · check-in free text available
2022-10-27
Report sent to call center — 12 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-28
Call 2 — Left Voicemail
2022-10-28
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna
2	2021-02-12	Moderna
3	2021-10-27	Moderna	Shingles

Call center

4 call center cases

2 successful · 2 unsuccessful

See the call center timeline

Free text

Release 5 — day 28, dose 2

2021-03-12

Symptoms: May have UTI-see dr Monday.

Release 8 — 3 months, dose 2

2021-05-14

Symptoms: Kidney stones

Release 10 — day 0, dose 3

2021-10-27

Systemic reaction (other): Shindrix shot arm very sore

Release 10 — days 1–6 daily, dose 3

2021-10-28

Systemic reaction (other): Headache but pretty sure it is Shindrix since it is causing more pain.

2021-10-29

Systemic reaction (other): Still sore with Shindrix but better

2021-10-30

Systemic reaction (other): Pretty sure it was still due to Shindrix

2021-11-01

Systemic reaction (other): Went to dr- have a UTI

2021-11-02

Systemic reaction (other): Due to UTI I am sure-not either vaccines

Release 10 — day 7, dose 3

2021-11-03

Systemic reaction (other): Still dealing with UTI

Release 11 — 6 months, dose 3

2022-04-27

Symptoms: Had 2nd shingle shot & arm very sore & large area has a red rash about 4" below injection site. Will check with dr tomorrow

Healthcare visit (other): Not sure yet

Release 12 — 12 months, dose 3

2022-10-27

Symptoms: Have had UTI's & fell outside & my left big toe has gotten infected so taking antibiotics & cream. Also having nerve problems & will have neck surgery in 2 months.

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	Unevaluable event	·	·	✓
SD	Fall	·	·	✓
SD	Injection site reaction	·	·	✓
SD	Localised infection	·	·	✓
SD	Nephrolithiasis	✓	✓	✓
SD	Nervous system disorder	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Rash erythematous	·	·	✓
SD	Urinary tract infection	✓	✓	✓
SRO	Adverse reaction	·	·	✓
SRO	Headache	·	·	✓
SRO	Office visit	·	·	✓
SRO	Pain	·	·	✓
SRO	Pain in extremity	·	·	✓
SRO	Urinary tract infection	·	·	✓

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