4XA-14831-00491

3 vaccinations 12 coded responses 37 check-ins 12 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 857 / AZ
Registered: 2021-02-26

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

2021-02-26
Registered in v-safe
2021-02-26
Dose 1 — Moderna
2021-02-26
Survey response — day 0, dose 1
MedDRA: Back pain, Fatigue — Feeling: Good · Be unable to work

Free text: a little tired and a slight ach in my upper left back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-07
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-12
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-26
Dose 2 — Moderna
2021-03-27
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Nausea — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea

Free text: This is second day... First day very dizzy and nauseous Slept till 6pm..Didn't want to get up. But had no choice had to prepare for next day. Went back to bed as fast as I could.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-28
Survey response — days 1–6 daily, dose 2
MedDRA: Blood pressure decreased, Blood pressure fluctuation, Condition aggravated, Hypotension, Pre-existing disease, Somnolence — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work

Free text: Blood pressure dropped really low 5:55am 82/67 pulse 67 at 2:40pm 173/67 pulse 62 blood pressure has been jumping up n down but never that low.. I really want to sleep but I have to much work to do. So I know I am pushing myself to keep working

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Free text: The itching was early this morning. But only lasted about a minute or so.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Frustration tolerance decreased — Feeling: Fair · Site: Pain · Fatigue or tiredness, Nausea · Be unable to work

Free text: Frustration

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness, Nausea

Adult check-in
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: Impaired work ability, Nausea — Feeling: Good · Fatigue or tiredness, Nausea

Free text: After resting a little bit the nausea passed and I was able to go back to work.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-01
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-01
Dose 3 — Moderna
Co-administered: Flu
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Poor · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Survey response — days 1–6 daily, dose 3
MedDRA: Feeling cold — Feeling: Poor · Site: Pain · Fever · Chills, Headache

Free text: I'm very cold

MedDRA releases: 2024-11 · check-in free text available
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-11-08
Survey response — day 7, dose 3
MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness

Free text: I got extra sleep yesterday. Didn't feel as tired today.

MedDRA releases: 2024-11 · check-in free text available
2021-11-16
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-22
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-29
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-06
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-13
Survey response — day 42, dose 3
MedDRA: Hypertension — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: My blood pressure is very high. I will be talking to physian Jan 22. I don't think it has to do with the covid shot. But I felt I should tell u.

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-12-14
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-31
Survey response — 3 months, dose 3
MedDRA: Blood pressure increased — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: My blood pressure is high. Testing medications as we speak to see what dosage will bring it down..

MedDRA releases: 2024-11 · check-in free text available
2022-01-31
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-02-02
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-03
Survey response — 6 months, dose 3
MedDRA: Fatigue, Hypertension — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Having higher blood pressure problems and seem to get tired faster

MedDRA releases: 2024-11 · check-in free text available
2022-05-03
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-01
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-26	Moderna
2	2021-03-26	Moderna
3	2021-11-01	Moderna	Flu

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 4 — day 0, dose 1

2021-02-26

Systemic reaction (other): a little tired and a slight ach in my upper left back

Release 6 — days 1–6 daily, dose 2

2021-03-27

Systemic reaction (other): This is second day... First day very dizzy and nauseous Slept till 6pm..Didn't want to get up. But had no choice had to prepare for next day. Went back to bed as fast as I could.

2021-03-28

Systemic reaction (other): Blood pressure dropped really low 5:55am 82/67 pulse 67 at 2:40pm 173/67 pulse 62 blood pressure has been jumping up n down but never that low.. I really want to sleep but I have to much work to do. So I know I am pushing myself to keep working

2021-03-29

Systemic reaction (other): The itching was early this morning. But only lasted about a minute or so.

2021-03-30

Systemic reaction (other): Frustration

2021-04-01

Systemic reaction (other): After resting a little bit the nausea passed and I was able to go back to work.

Release 10 — days 1–6 daily, dose 3

2021-11-02

Systemic reaction (other): No

2021-11-03

Systemic reaction (other): I'm very cold

Release 10 — day 7, dose 3

2021-11-08

Systemic reaction (other): I got extra sleep yesterday. Didn't feel as tired today.

Release 10 — day 42, dose 3

2021-12-13

Symptoms: My blood pressure is very high. I will be talking to physian Jan 22. I don't think it has to do with the covid shot. But I felt I should tell u.

Release 11 — 3 months, dose 3

2022-01-31

Symptoms: My blood pressure is high. Testing medications as we speak to see what dosage will bring it down..

Release 11 — 6 months, dose 3

2022-05-03

Symptoms: Having higher blood pressure problems and seem to get tired faster

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	Blood pressure increased	·	·	✓
SD	Fatigue	·	·	✓
SD	Hypertension	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Blood pressure decreased	✓	✓	✓
SRO	Blood pressure fluctuation	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Feeling cold	·	·	✓
SRO	Frustration tolerance decreased	✓	✓	✓
SRO	Hypotension	✓	✓	✓
SRO	Impaired work ability	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Somnolence	✓	✓	✓

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