4KZ-22936-65823

3 vaccinations 9 coded responses 25 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 067 / CT
Registered: 2021-04-18

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

2021-03-25
Dose 1 — Moderna
2021-04-18
Registered in v-safe
2021-04-18
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-22
Dose 2 — Moderna
2021-04-22
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Dyspnoea, Heart rate increased, Pyrexia, Rash, Self-medication — Feeling: Poor · Site: Pain, Redness, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: First 12 hours after shot...No reactions. At about 14 hours after shot these symtoms all appeared with addition of rashes today...4th day after shot. Went to ER for care. Pulse is still very high...making me out of breath...lungs clear by 4th day. Fever broke on 4th day. Was given Benadryl, Prednisone and pepcid. Called my pharmacist for prescription to all 3 for4 days?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-25
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-27
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia — Feeling: Fair · Site: Pain, Redness · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Body weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-29
Survey response — day 7, dose 2
MedDRA: Erythema, Stomatitis, Urticaria — Feeling: Good

Free text: Sores on roof of mouth for several days. Woke with about 7 welt like red spots around waist. Mildly itchy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-20
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-27
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-22
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-21
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-08
Dose 3 — Moderna
2021-12-11
Survey response — days 1–6 daily, dose 3
MedDRA: Pain in jaw — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Pain in jaw

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site erythema — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Areas of red patches well below shot area.

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Survey response — days 1–6 daily, dose 3
MedDRA: Oropharyngeal pain, Pain in jaw — Feeling: Fair · Fatigue or tiredness

Free text: Jaw ache. Sore throat.

MedDRA releases: 2024-11 · check-in free text available
2021-12-14
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Gait disturbance, Pain — Feeling: Good

Free text: Knees painful walking stairs

MedDRA releases: 2024-11 · check-in free text available
2021-12-15
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-22
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-29
Survey response — day 21, dose 3
MedDRA: Axillary pain, Tenderness — Feeling: Good

Free text: Ache in the pit of my arm the shot went in. Sore to touch in front area of arm pit.

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Call 1 — Left Voicemail
2022-01-05
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-14
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-19
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-09
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-12-08
Survey response — 12 months, dose 3
MedDRA: COVID-19, Cough, Eye pain, Headache, Laryngitis, Pain in jaw, Pyrexia, Respiratory tract congestion, Rhinorrhoea, Sneezing — 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: Covid positive. Aches in jaw, temples, head, eyes. Fever 101.5. Cough. Laryngitis. Sneezing. Runny nose. Stuffed head.

MedDRA releases: 2024-11 · check-in free text available
2022-12-08
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)
2022-12-09
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-09
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	2021-03-25	Moderna
2	2021-04-22	Moderna
3	2021-12-08	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

2021-04-25

Systemic reaction (other): First 12 hours after shot...No reactions. At about 14 hours after shot these symtoms all appeared with addition of rashes today...4th day after shot. Went to ER for care. Pulse is still very high...making me out of breath...lungs clear by 4th day. Fever broke on 4th day. Was given Benadryl, Prednisone and pepcid. Called my pharmacist for prescription to all 3 for4 days?

Release 8 — days 1–6 daily, dose 2

2021-04-27

Systemic reaction (other): Body weakness

Release 8 — day 7, dose 2

2021-04-29

Systemic reaction (other): Sores on roof of mouth for several days. Woke with about 7 welt like red spots around waist. Mildly itchy.

Release 10 — days 1–6 daily, dose 3

2021-12-11

Systemic reaction (other): Pain in jaw

2021-12-12

Systemic reaction (other): Areas of red patches well below shot area.

2021-12-13

Systemic reaction (other): Jaw ache. Sore throat.

2021-12-14

Systemic reaction (other): Knees painful walking stairs

Release 10 — day 21, dose 3

2021-12-29

Symptoms: Ache in the pit of my arm the shot went in. Sore to touch in front area of arm pit.

Release 12 — 12 months, dose 3

2022-12-08

Symptoms: Covid positive. Aches in jaw, temples, head, eyes. Fever 101.5. Cough. Laryngitis. Sneezing. Runny nose. Stuffed head.

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	Axillary pain	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Eye pain	·	·	✓
SD	Headache	·	·	✓
SD	Laryngitis	·	·	✓
SD	Pain in jaw	·	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Sneezing	·	·	✓
SD	Tenderness	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Gait disturbance	·	·	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Injection site erythema	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	Pain	·	·	✓
SRO	Pain in jaw	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Stomatitis	✓	✓	✓
SRO	Urticaria	✓	✓	✓

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