4TX-77889-10803

4 vaccinations 8 coded responses 50 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 300 / GA
Registered: 2021-02-07

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-05
Dose 1 — Moderna
2021-02-07
Registered in v-safe
2021-02-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-09
Dose 2 — Moderna
2021-03-09
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tiredness, Nausea, Abdominal pain

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-23
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-30
Survey response — day 21, dose 2
MedDRA: Arthralgia, Pain — Feeling: Good

Free text: aDont know if related, but occasional jabbing pains in various parts of the body. Not limited to joints. Especially before the last bad storm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-08
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-09-09
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Pain — Feeling: Fair

Free text: Seem to have pains in throughout parts of the body with no reason. Some joint, some not, some fleeting, some lasting. The night of last vaccine there were pains as if someone banged ankle with small hammer for a couple of minutes then it may be arm.

MedDRA releases: 2024-11 · check-in free text available
2021-10-25
Dose 3 — Moderna
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness, Swelling, Itching · Headache

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-11-01
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-15
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-24
Survey response — 3 months, dose 3
MedDRA: COVID-19, SARS-CoV-2 test — Feeling: Good · 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: Symptoms: Covid positive · Healthcare visit (other): Covid test

MedDRA releases: 2024-11 · check-in free text available
2022-01-24
Report sent to call center — 3 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)
2022-01-26
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-20
Dose 4 — Moderna
2022-04-20
Survey response — day 0, dose 4
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2022-04-21
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain, Swelling · None

Adult check-in
2022-04-22
Survey response — days 1–6 daily, dose 4
MedDRA: Body temperature increased, Feeling hot — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: These symptoms were mostly last night after yesterday's report. Suddenly hottemp was up one degree

MedDRA releases: 2024-11 · check-in free text available
2022-04-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Itching · None

Adult check-in
2022-04-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Adult check-in
2022-04-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-26
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-27
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-04
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-11
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-18
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-27
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-01
Survey response — day 42, dose 4
MedDRA: Injection site nodule, Injection site pruritus, Injection site swelling — Feeling: Fair

Free text: Swollen and itchy nodule at sight of vaccine injection

MedDRA releases: 2024-11 · check-in free text available
2022-07-20
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-22
Survey response — 6 months, dose 4
MedDRA: Office visit, Red blood cell sedimentation rate increased — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: ESR 72 · Healthcare visit (other): Dr visits, biopsy

MedDRA releases: 2024-11 · check-in free text available
2022-10-22
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-10-26
Call successful
Not applicable - Accidental Reporting
2023-04-20
Survey response — 12 months, dose 4
MedDRA: Anaemia, Inflammation, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-04-20
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2023-04-21
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-09	Moderna
3	2021-10-25	Moderna	No
4	2022-04-20	Moderna	No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 6 — day 21, dose 2

2021-03-30

Symptoms: aDont know if related, but occasional jabbing pains in various parts of the body. Not limited to joints. Especially before the last bad storm.

Release 9 — 6 months, dose 2

2021-09-09

Symptoms: Seem to have pains in throughout parts of the body with no reason. Some joint, some not, some fleeting, some lasting. The night of last vaccine there were pains as if someone banged ankle with small hammer for a couple of minutes then it may be arm. cut off by CDC

Release 11 — 3 months, dose 3

2022-01-24

Symptoms: Covid positive

Healthcare visit (other): Covid test

Release 11 — day 0, dose 4

2022-04-20

Systemic reaction (other): No

Release 11 — days 1–6 daily, dose 4

2022-04-22

Systemic reaction (other): These symptoms were mostly last night after yesterday's report. Suddenly hottemp was up one degree

Release 11 — day 42, dose 4

2022-06-01

Symptoms: Swollen and itchy nodule at sight of vaccine injection

Release 12 — 6 months, dose 4

2022-10-22

Symptoms: ESR 72

Healthcare visit (other): Dr visits, biopsy

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	·	·	✓
HCVO	SARS-CoV-2 test	·	·	✓
SD	Anaemia	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	COVID-19	·	·	✓
SD	Inflammation	·	·	✓
SD	Injection site nodule	·	·	✓
SD	Injection site pruritus	·	·	✓
SD	Injection site swelling	·	·	✓
SD	Pain	✓	✓	✓
SD	Red blood cell sedimentation rate increased	·	·	✓
SRO	Body temperature increased	·	·	✓
SRO	Feeling hot	·	·	✓
SRO	No adverse event	·	·	✓

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