4JU-22645-31369

3 vaccinations 11 coded responses 21 check-ins 11 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 200 / DC
Registered: 2021-02-10

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
Dose 1 — Moderna
2021-02-10
Registered in v-safe
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
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain

Free text: My husband has the same arm pain and he has body aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Paraesthesia oral — Feeling: Good · Site: Pain

Free text: My tongue has been raw feeling since the day after the shot. I still have my sense of taste snd smell

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 2
MedDRA: Tongue discomfort — Feeling: Good · Site: Pain

Free text: My mouth is better but my tongue still fells like it was burned by hot liquid

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: Dysgeusia, Stomatitis — Feeling: Good · Site: Pain

Free text: Mouth still has odd taste and is irritated

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: Oral pain, Stomatitis — Feeling: Good

Free text: My mouth feels less tender and raw

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — day 7, dose 2
MedDRA: Adverse reaction — Feeling: Good

Free text: Mouth is improving

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
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
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

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

Adult check-in
2021-05-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-18
Dose 3 — Moderna
2021-10-26
Survey response — day 7, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Survey response — day 14, dose 3
MedDRA: Injection site pain — Feeling: Good

Free text: Pain at injection site -

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Survey response — day 28, dose 3
MedDRA: Office visit, Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: UTI · Healthcare visit (other): Saw my urologist

MedDRA releases: 2024-11 · check-in free text available
2021-11-15
Report sent to call center — day 28, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-11-17
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-22
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-17
Survey response — 3 months, dose 3
MedDRA: Oropharyngeal pain — Feeling: Good

Free text: Slightly sore throat

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Survey response — 6 months, dose 3
MedDRA: COVID-19, Medical counselling — Feeling: Good · 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: Symptoms: I had covid Feb 28 · Healthcare visit (other): Spoke to my internist on the phone

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-04-21
Call successful
Not applicable - Accidental Reporting
2022-10-18
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-12	Moderna
2	2021-02-10	Moderna
3	2021-10-18	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): My husband has the same arm pain and he has body aches

2021-02-13

Systemic reaction (other): My tongue has been raw feeling since the day after the shot. I still have my sense of taste snd smell

2021-02-14

Systemic reaction (other): My mouth is better but my tongue still fells like it was burned by hot liquid

2021-02-15

Systemic reaction (other): Mouth still has odd taste and is irritated

2021-02-16

Systemic reaction (other): My mouth feels less tender and raw

Release 4 — day 7, dose 2

2021-02-17

Systemic reaction (other): Mouth is improving

Release 10 — day 7, dose 3

2021-10-26

Systemic reaction (other): No

Release 10 — day 14, dose 3

2021-11-01

Symptoms: Pain at injection site -

Release 10 — day 28, dose 3

2021-11-15

Symptoms: UTI

Healthcare visit (other): Saw my urologist

Release 10 — 3 months, dose 3

2022-01-17

Symptoms: Slightly sore throat

Release 11 — 6 months, dose 3

2022-04-20

Symptoms: I had covid Feb 28

Healthcare visit (other): Spoke to my internist on the phone

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	Medical counselling	·	·	✓
HCVO	Office visit	·	·	✓
SD	COVID-19	·	·	✓
SD	Injection site pain	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Dysgeusia	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Oral pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia oral	✓	✓	✓
SRO	Stomatitis	✓	✓	✓
SRO	Tongue discomfort	✓	✓	✓

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