4WQ-55712-97336

2 vaccinations 10 coded responses 18 check-ins 10 free-text entries 0 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 937 / CA
Registered: 2021-02-15

Relationship: Self
Race: Other
Ethnicity: Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-02-15
Registered in v-safe
2021-02-15
Dose 1 — Moderna
2021-02-15
Survey response — day 0, dose 1
MedDRA: Erythema, Pruritus, Skin warm — Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: Above right elbow is red and hor to the touch slight itch

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-18
Survey response — days 1–6 daily, dose 1
MedDRA: Diarrhoea, Faeces discoloured — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Tar like stools

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 1
MedDRA: Blood pressure fluctuation — Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Free text: Bp was all over the map 137/94, 145/105,210/91

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness · Be unable to work

Adult check-in
2021-02-22
Survey response — day 7, dose 1
MedDRA: Irritability — Feeling: Fair · Site: Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Irritability

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-15
Dose 2 — Moderna
2021-03-16
Survey response — days 1–6 daily, dose 2
MedDRA: Apathy, Heart rate increased, Hypertension, Lethargy — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: High bp and high resting heartrate extremely lethargic zero motivation irritable

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-17
Survey response — days 1–6 daily, dose 2
MedDRA: Apathy, Malaise — Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Malaise.. Zero motivation. I am struggling to eveb shower

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-21
Survey response — days 1–6 daily, dose 2
MedDRA: Blister, Ear discomfort, Ear pain, Ear swelling, Rash pruritic — Feeling: Good · Site: Pain, Itching · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Free text: Extreme itching little bumps all ovet Also had ear ache and a blister on my ear.. Ear felt clogged swolien

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 7, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-29
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-07
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-15
Survey response — day 28, dose 2
MedDRA: Fatigue — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — day 35, dose 2
MedDRA: Fatigue, Feeling abnormal — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: Extreme fatigue with intense brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-28
Survey response — day 42, dose 2
MedDRA: Fatigue, Injection site rash, Rash, Rash pruritic — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Itchy bumps on arms torso and especially around injection site.Moderate to sevwre fatigue . severe enough to have had a bottle kf water pouref on me By my 20 month old son and i dis nor evwm move let alone react.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-15	Moderna
2	2021-03-15	Moderna

Free text

Release 4 — day 0, dose 1

2021-02-15

Systemic reaction (other): Above right elbow is red and hor to the touch slight itch

Release 4 — days 1–6 daily, dose 1

2021-02-18

Systemic reaction (other): Tar like stools

2021-02-20

Systemic reaction (other): Bp was all over the map 137/94, 145/105,210/91

Release 4 — day 7, dose 1

2021-02-22

Systemic reaction (other): Irritability

Release 5 — days 1–6 daily, dose 2

2021-03-16

Systemic reaction (other): High bp and high resting heartrate extremely lethargic zero motivation irritable

2021-03-17

Systemic reaction (other): Malaise.. Zero motivation. I am struggling to eveb shower

Release 6 — days 1–6 daily, dose 2

2021-03-21

Systemic reaction (other): Extreme itching little bumps all ovet Also had ear ache and a blister on my ear.. Ear felt clogged swolien

Release 7 — day 28, dose 2

2021-04-15

Symptoms: Fatigue

Release 7 — day 35, dose 2

2021-04-19

Symptoms: Extreme fatigue with intense brain fog

Release 8 — day 42, dose 2

2021-04-28

Symptoms: Itchy bumps on arms torso and especially around injection site.Moderate to sevwre fatigue . severe enough to have had a bottle kf water pouref on me By my 20 month old son and i dis nor evwm move let alone react.

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	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SRO	Apathy	✓	✓	✓
SRO	Blister	✓	✓	✓
SRO	Blood pressure fluctuation	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Ear discomfort	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Ear swelling	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Faeces discoloured	✓	✓	✓
SRO	Heart rate increased	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Irritability	✓	✓	✓
SRO	Lethargy	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash pruritic	✓	✓	✓
SRO	Skin warm	✓	✓	✓

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