4VM-48014-47577

2 vaccinations 10 coded responses 25 check-ins 10 free-text entries 1 call case

Sex: Female
Age at first dose: 61-65
ZIP prefix: 939 / CA
Registered: 2021-05-06

Relationship: Self
Race: N/A
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-05-05
Dose 1 — Moderna
2021-05-06
Registered in v-safe
2021-05-06
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Site: Pain · Fever · Chills, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-05-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-08
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Palpitations — Feeling: Good · Headache

Free text: Heart racing and a little bit of a headache thats it

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-10
Survey response — days 1–6 daily, dose 1
MedDRA: Influenza — Feeling: Fair · Muscle or body aches

Free text: Flu

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — days 1–6 daily, dose 1
MedDRA: Nasopharyngitis — Feeling: Fair · Site: Swelling · Muscle or body aches

Free text: I caught a cold from one of my grandkids

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Health check-in — day 7, dose 1
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-26
Survey response — day 21, dose 1
MedDRA: Dyspnoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: I couldnt breathe well before but after I had the Covid in December Im not sure about the shot I am suffocating because I only have one lung

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Dose 2 — Moderna
2021-06-02
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-06-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches

Adult check-in
2021-06-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-06-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-09
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-06-16
Survey response — day 14, dose 2
MedDRA: Chest pain, Dyspnoea — Feeling: Good

Free text: Im having extreme breathing problems and chest pains

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-23
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-06-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-07-07
Survey response — day 35, dose 2
MedDRA: Chest pain, Condition aggravated, Dyspnoea, Headache, Pre-existing disease, Self-medication — Feeling: Fair

Free text: I had breathing problems before all this but my breathing problems are far more worse and chest pains with throbbing headache and pulsating on the side temples of each side of my head I end up taking Tylenol

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-14
Survey response — day 42, dose 2
MedDRA: Dyspnoea — Feeling: Good

Free text: My breathing was already compromised but my breathing has gotten worse struggling to get air

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-01
Survey response — 3 months, dose 2
MedDRA: Dyspnoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Its hard for me to breathe and Im finding myself doing my breathing medication more often than usual

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-12-03
Survey response — 6 months, dose 2
MedDRA: Dyspnoea, Headache, Influenza like illness, Office visit, Pre-existing disease — Feeling: Fair · 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: Flu like symptoms major headaches in the temple areas of my head and harder to breathe but I think that Hass to do with the Covid I had in December 2019 · Healthcare visit (other): Dr. Harry Jang

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
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

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-06-02
Survey response — 12 months, dose 2
MedDRA: Headache, Malaise — Feeling: Fair

Free text: I feel sick all the time and I get these massive bad headaches like a knife sticking me in the brain

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-05	Moderna
2	2021-06-02	Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-08

Systemic reaction (other): Heart racing and a little bit of a headache thats it

2021-05-10

Systemic reaction (other): Flu

2021-05-11

Systemic reaction (other): I caught a cold from one of my grandkids

Release 8 — day 21, dose 1

2021-05-26

Symptoms: I couldnt breathe well before but after I had the Covid in December Im not sure about the shot I am suffocating because I only have one lung

Release 9 — day 14, dose 2

2021-06-16

Symptoms: Im having extreme breathing problems and chest pains

Release 9 — day 35, dose 2

2021-07-07

Symptoms: I had breathing problems before all this but my breathing problems are far more worse and chest pains with throbbing headache and pulsating on the side temples of each side of my head I end up taking Tylenol

Release 9 — day 42, dose 2

2021-07-14

Symptoms: My breathing was already compromised but my breathing has gotten worse struggling to get air

Release 9 — 3 months, dose 2

2021-09-01

Symptoms: Its hard for me to breathe and Im finding myself doing my breathing medication more often than usual

Release 10 — 6 months, dose 2

2021-12-03

Symptoms: Flu like symptoms major headaches in the temple areas of my head and harder to breathe but I think that Hass to do with the Covid I had in December 2019

Healthcare visit (other): Dr. Harry Jang

Release 11 — 12 months, dose 2

2022-06-02

Symptoms: I feel sick all the time and I get these massive bad headaches like a knife sticking me in the brain

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	Chest pain	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Influenza like illness	·	·	✓
SD	Malaise	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Self-medication	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Influenza	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	Palpitations	✓	✓	✓

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