4LM-34009-22135

4 vaccinations 24 coded responses 37 check-ins 24 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 930 / CA
Registered: 2021-03-10

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

2021-03-10
Registered in v-safe
2021-03-10
Dose 1 — Moderna
2021-03-10
Survey response — day 0, dose 1
MedDRA: Diarrhoea, Pre-existing disease, Stoma site pain — Feeling: Good · Site: Pain · Diarrhea

Free text: I just have my normal stoma pain from my j tube and loose bowels all week due to antibiotics for 8 days last week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Sore left arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site erythema, Injection site swelling — Feeling: Good · Site: Pain, Swelling

Free text: Slightly swollen and red at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · Fatigue or tiredness

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-03-15
Survey response — days 1–6 daily, dose 1
MedDRA: Arthritis, Pneumonia, Pre-existing disease — Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea, Abdominal pain

Free text: Above symptoms are probably due to my J tube, age, getting over pneumonia since 3/2, and arthritis pain.

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

Free text: Just my normal old age tired and sometimes out of breath.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-24
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-31
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-04-08
Dose 2 — Moderna
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · None

Adult check-in
2021-04-13
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — days 1–6 daily, dose 2
MedDRA: Night sweats — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Excessive night sweating

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — day 7, dose 2
MedDRA: No adverse event — Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-29
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-13
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-20
Survey response — day 42, dose 2
MedDRA: Fatigue, Pain, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: Slight temp, body aches, very tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-08
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Body temperature increased, Bronchiectasis, Cough, Fatigue, Hyperhidrosis, Productive cough, Pyrexia, Sputum discoloured — Feeling: Fair · Be unable to do your normal daily activities

Free text: Temp of 99.4 one day. Tired, feverish, sweaty, coughing up colored phlegm, and achy joints. I just finished ten days of Cefuroxime for my bronchiastisis and feel much better. I did send a sputum sample to the lab. No results yet.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-07
Survey response — 6 months, dose 2
MedDRA: Body temperature increased, Bronchiectasis, Escherichia infection, Office visit, Pseudomonas infection — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: I have a slight temp with bronchiastisis due to Pseudomonas seruguinos and Escherichia coli in my lungs. · Healthcare visit (other): In office pulmonary doctor appointment

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-12
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-12-16
Dose 3 — Moderna
2022-04-08
Survey response — 12 months, dose 2
MedDRA: Abdominal pain, Asthenia, Back pain, Depression, Fatigue, Office visit, Productive cough, Secretion discharge, Urinary tract infection — 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: Symptoms: Exhaustion, abdominal and back pain, UTI, no energy, coughing up mucous, and depression. · Healthcare visit (other): In office doctor appointments.

MedDRA releases: 2024-11 · check-in free text available
2022-04-08
Report sent to call center — 12 months, dose 2
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)
2022-04-19
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-24
Dose 4 — Moderna
2022-08-24
Survey response — day 0, dose 4
MedDRA: Asthenia, Bronchitis, Fatigue, Middle ear effusion, Vulvovaginal mycotic infection — Feeling: Poor · Site: Pain · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Oral thrush? Vaginal yeast infection, bronchial infection, fluid in ears, weakness, tiredness.

MedDRA releases: 2024-11 · check-in free text available
2022-08-25
Survey response — days 1–6 daily, dose 4
MedDRA: Oral candidiasis, Oral herpes — Feeling: Poor · Site: Pain · Fever · Fatigue or tiredness, Vomiting, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Oral thrush or herpes

MedDRA releases: 2024-11 · check-in free text available
2022-08-26
Survey response — days 1–6 daily, dose 4
MedDRA: Oral candidiasis, Skin exfoliation — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Oral thrush seems to be decreasing and tissue sloughing off.

MedDRA releases: 2024-11 · check-in free text available
2022-08-27
Survey response — days 1–6 daily, dose 4
MedDRA: Oral candidiasis — Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Oral thrush still active

MedDRA releases: 2024-11 · check-in free text available
2022-08-29
Survey response — days 1–6 daily, dose 4
MedDRA: Oral candidiasis — Feeling: Fair · Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Still battling oral thrush.

MedDRA releases: 2024-11 · check-in free text available
2022-08-30
Survey response — days 1–6 daily, dose 4
MedDRA: Bronchiectasis, Oral candidiasis, Productive cough — Feeling: Fair · Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Still fighting oral thrush. Some productive coughing due to bronchiastisis.

MedDRA releases: 2024-11 · check-in free text available
2022-08-31
Survey response — day 7, dose 4
MedDRA: Oral candidiasis — Feeling: Fair · Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Still having oral thrush outbreak.

MedDRA releases: 2024-11 · check-in free text available
2022-09-09
Survey response — day 14, dose 4
MedDRA: Petechiae — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Deep purple blood leakages under my skin on my arms and legs. Conserning to me.

MedDRA releases: 2024-11 · check-in free text available
2022-09-14
Survey response — day 21, dose 4
MedDRA: Pain in extremity, Pain of skin, Tenderness — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: My skin on my arms and legs feel like stickers are imbedded in the pores. It hurts to rub them. Putting on lots of cream helps.

MedDRA releases: 2024-11 · check-in free text available
2022-09-21
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-09-28
Survey response — day 35, dose 4
MedDRA: Abdominal pain, Arthralgia, Condition aggravated, Deafness unilateral, Diarrhoea, Gastric pH decreased, Pain in extremity, Pre-existing disease — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Thrush has returned. Pain in my abdomen and left hip. Leg and arms hurt. Diarrhea returned. Excess gastric acid. Loss of hearing in left ear.

MedDRA releases: 2024-11 · check-in free text available
2022-10-05
Survey response — day 42, dose 4
MedDRA: Asthenia, Depression, Fatigue, Hypoacusis, Pain in extremity, Peripheral swelling — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Partial loss of hearing in left ear, leg and foot swelling, pain in legs and arms, tiredness, weakness, and depression.

MedDRA releases: 2024-11 · check-in free text available
2022-11-25
Survey response — 3 months, dose 4
MedDRA: Asthenia, Back pain, Decreased appetite, Depression, Fatigue, Musculoskeletal pain, Pain, Pain in extremity, Palpitations, Peripheral swelling, Weight decreased — Feeling: Poor · 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: Exhaustion, depression, loss of appetite, swelling in my feet and legs, loss of weight, heart racing, prickly pain on my arms and now my legs all the way to my buttocks, back pain, leg pain, no energy to leave my room, no appetite, and generally mise

MedDRA releases: 2024-11 · check-in free text available
2022-11-25
Report sent to call center — 3 months, dose 4
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)
2022-11-29
Call 1 — Requested Callback
2022-12-12
Call 2 — Requested Callback
2022-12-21
Call 3 — Left Voicemail
2022-12-21
Callback requested for
05:00PM ET

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-10	Moderna
2	2021-04-08	Moderna
3	2021-12-16	Moderna	No
4	2022-08-24	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-10

Systemic reaction (other): I just have my normal stoma pain from my j tube and loose bowels all week due to antibiotics for 8 days last week.

Release 5 — days 1–6 daily, dose 1

2021-03-11

Systemic reaction (other): Sore left arm

2021-03-12

Systemic reaction (other): Slightly swollen and red at injection site

2021-03-15

Systemic reaction (other): Above symptoms are probably due to my J tube, age, getting over pneumonia since 3/2, and arthritis pain.

2021-03-16

Systemic reaction (other): Just my normal old age tired and sometimes out of breath.

Release 7 — days 1–6 daily, dose 2

2021-04-13

Systemic reaction (other): No

2021-04-14

Systemic reaction (other): Excessive night sweating

Release 7 — day 7, dose 2

2021-04-15

Systemic reaction (other): No

Release 8 — day 42, dose 2

2021-05-20

Symptoms: Slight temp, body aches, very tired

Release 9 — 3 months, dose 2

2021-07-08

Symptoms: Temp of 99.4 one day. Tired, feverish, sweaty, coughing up colored phlegm, and achy joints. I just finished ten days of Cefuroxime for my bronchiastisis and feel much better. I did send a sputum sample to the lab. No results yet.

Release 10 — 6 months, dose 2

2021-10-07

Symptoms: I have a slight temp with bronchiastisis due to Pseudomonas seruguinos and Escherichia coli in my lungs.

Healthcare visit (other): In office pulmonary doctor appointment

Release 11 — 12 months, dose 2

2022-04-08

Symptoms: Exhaustion, abdominal and back pain, UTI, no energy, coughing up mucous, and depression.

Healthcare visit (other): In office doctor appointments.

Release 12 — day 0, dose 4

2022-08-24

Systemic reaction (other): Oral thrush? Vaginal yeast infection, bronchial infection, fluid in ears, weakness, tiredness.

Release 12 — days 1–6 daily, dose 4

2022-08-25

Systemic reaction (other): Oral thrush or herpes

2022-08-26

Systemic reaction (other): Oral thrush seems to be decreasing and tissue sloughing off.

2022-08-27

Systemic reaction (other): Oral thrush still active

2022-08-29

Systemic reaction (other): Still battling oral thrush.

2022-08-30

Systemic reaction (other): Still fighting oral thrush. Some productive coughing due to bronchiastisis.

Release 12 — day 7, dose 4

2022-08-31

Systemic reaction (other): Still having oral thrush outbreak.

Release 12 — day 14, dose 4

2022-09-09

Symptoms: Deep purple blood leakages under my skin on my arms and legs. Conserning to me.

Release 12 — day 21, dose 4

2022-09-14

Symptoms: My skin on my arms and legs feel like stickers are imbedded in the pores. It hurts to rub them. Putting on lots of cream helps.

Release 12 — day 35, dose 4

2022-09-28

Symptoms: Thrush has returned. Pain in my abdomen and left hip. Leg and arms hurt. Diarrhea returned. Excess gastric acid. Loss of hearing in left ear.

Release 12 — day 42, dose 4

2022-10-05

Symptoms: Partial loss of hearing in left ear, leg and foot swelling, pain in legs and arms, tiredness, weakness, and depression.

Release 12 — 3 months, dose 4

2022-11-25

Symptoms: Exhaustion, depression, loss of appetite, swelling in my feet and legs, loss of weight, heart racing, prickly pain on my arms and now my legs all the way to my buttocks, back pain, leg pain, no energy to leave my room, no appetite, and generally mise cut off by CDC

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	Office visit	·	·	✓
SD	Abdominal pain	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Asthenia	·	·	✓
SD	Back pain	·	·	✓
SD	Body temperature increased	✓	✓	✓
SD	Bronchiectasis	✓	✓	✓
SD	Condition aggravated	·	·	✓
SD	Cough	✓	✓	○
SD	Deafness unilateral	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Depression	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Escherichia infection	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Gastric pH decreased	·	·	✓
SD	Hyperhidrosis	✓	✓	✓
SD	Hypoacusis	·	·	✓
SD	Musculoskeletal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Pain of skin	·	·	✓
SD	Palpitations	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Petechiae	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Productive cough	·	·	✓
SD	Pseudomonas infection	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Secretion discharge	·	·	✓
SD	Sputum discoloured	·	·	✓
SD	Tenderness	·	·	✓
SD	Urinary tract infection	·	·	✓
SD	Weight decreased	·	·	✓
SRO	Arthritis	✓	✓	✓
SRO	Asthenia	·	·	✓
SRO	Bronchiectasis	·	·	✓
SRO	Bronchitis	·	·	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Middle ear effusion	·	·	✓
SRO	Night sweats	✓	✓	✓
SRO	No adverse event	✓	✓	✓
SRO	Oral candidiasis	·	·	✓
SRO	Oral herpes	·	·	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pneumonia	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Productive cough	·	·	✓
SRO	Skin exfoliation	·	·	✓
SRO	Stoma site pain	○	✓	○
SRO	Vulvovaginal mycotic infection	·	·	✓

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