52V-27889-76764

2 vaccinations 17 coded responses 24 check-ins 17 free-text entries 6 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 650 / MO
Registered: 2021-03-05

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

2021-03-05
Registered in v-safe
2021-03-05
Dose 1 — Moderna
2021-03-05
Survey response — day 0, dose 1
MedDRA: Anxiety, Crying, Depression, Dizziness, Feeling cold, Lacrimation increased, Paraesthesia, Paranasal sinus hypersecretion — Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizzy, tingly, paresthesia, Nadal drainage, crying / anxiety/ depression. Watery eyes. Cold feeling.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal distension, Flatulence — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Bloating and gas

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling hot, Flushing, Hyperhidrosis, Joint range of motion decreased — Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness

Free text: Limited range of movement in my shot arm x3 days, sweating, hot /flushed x2d,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Photophobia, Pyrexia — Feeling: Good · Site: Pain · Headache

Free text: Behind my eyes and fever forehead entire time, light entire time light sensitive but a bit better today. A few chills tonight

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

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Joint pains

Adult check-in
2021-03-11
Survey response — days 1–6 daily, dose 1
MedDRA: Depression — Feeling: Fair · Chills, Joint pains

Free text: Depression

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-21
Survey response — day 14, dose 1
MedDRA: Anxiety, Depression, Headache — Feeling: Fair · Be unable to work

Free text: Headache around my eyes have returned. Might be unrelated but continuing and worsening anxiety frustration impatience which cycles to depression and crying. Has prevented me from driving, my other source of income. Still in bed today, almost 4pm omg

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-04-03
Dose 2 — Moderna
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Itching mild dizziness mild to moderate

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus, Unevaluable event — Feeling: Fair · Site: Pain · Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): Severe persistentScalp itching since last checkin. Used husbands dandruff shampoo rinsed again later, covered scalp in morracan oil and put my hair up to try to deter continued scratching. Spoke with np office who denied correlation. Was total body itching immediately at 2nd injection, slightly so after the 1st inj · Healthcare visit (other): Phoned again np office and get ns called me back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Report sent to call center — days 1–6 daily, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-08
Survey response — days 1–6 daily, dose 2
MedDRA: Irritability, Nausea — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: Been nauseated 3 days. Extremely irritable

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-10
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Adult check-in
2021-04-17
Survey response — day 14, dose 2
MedDRA: Cystitis, Diarrhoea, Fatigue, Gastritis, Lethargy, Malaise, Urinary tract infection — Feeling: Fair · Be unable to do your normal daily activities

Free text: Gastritis, urinate cystitis or uti, urinate pressure and frequency, diarrhea, gas, fatigue and lethargy, malaise

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Survey response — day 21, dose 2
MedDRA: Dysuria, Gastrointestinal disorder, Nephrolithiasis, Peripheral swelling, Pollakiuria — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Kidney stones, bowel troubles, frequent painful urination, limb swelling

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-01
Survey response — day 28, dose 2
MedDRA: Hallucination, auditory, Hypersomnia, Insomnia, Mania — Feeling: Fair · Be unable to do your normal daily activities

Free text: Hypersomnia, insomnia, auditory hallucinations, mania,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Survey response — day 35, dose 2
MedDRA: Back pain, Bladder discomfort, Depression, Fatigue, Insomnia, Suicidal ideation — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Probable uti and likely nephritis note on azo and keflex. Still passing stones. Back pain bladder discomfort and urinate track pain/sensitivity. Fatigue. Sometimes insomnia. Severe depression with occasional SI. Had to change a medication last week

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Report sent to call center — day 35, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-17
Survey response — day 42, dose 2
MedDRA: Arthralgia, Back pain, Fatigue, Fibromyalgia, Headache, Office visit, Skin burning sensation — Feeling: Fair · Be unable to work, 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: Crippling Fatigue, lability of mood, fibromyalgia joint and muscle pain, uti was negative but to continue on keflex. Back pain. Had to use my cane some bc r knee pain, fatigue or dizzy. Burning skin and allergy reactions unseen in yrs. constipation · Healthcare visit (other): Recommended CT scan but providers not in agreement

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Report sent to call center — day 42, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-03
Survey response — 3 months, dose 2
MedDRA: Appendicitis, Fatigue, Headache, Migraine, Office visit, Ovarian cyst, Pain, Pre-existing disease, Stent placement, Ureteral stent insertion, Ureteric obstruction, Ureterolithiasis — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Ureter stones requiring a scope, lithotripsy and stent placement. L rotator cuff needing repeat surgery, increase in pain patch and flexaril, R large complex ovarian cyst, appendicitis, migraines and headaches, continued extreme fatigue and mentalhth · Healthcare visit (other): Regular occurring visits

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-03
Report sent to call center — 3 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

1 call case(s)
2021-07-07
Call 1 — Could Not Reach Participant
2022-04-03
Survey response — 12 months, dose 2
MedDRA: Amenorrhoea, Avulsion fracture, Dizziness, Hypersomnia, Lethargy, Memory impairment — Feeling: Fair · 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: Elbow avulsion, ammenorheia not due to menapause, dizziness, lethargy, excessive sleep, memory problems

MedDRA releases: 2024-11 · check-in free text available
2022-04-03
Report sent to call center — 12 months, dose 2
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)
2022-04-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-05	Moderna
2	2021-04-03	Moderna

Call center

6 call center cases

6 unsuccessful

See the call center timeline

Free text

Release 5 — day 0, dose 1

2021-03-05

Systemic reaction (other): Dizzy, tingly, paresthesia, Nadal drainage, crying / anxiety/ depression. Watery eyes. Cold feeling.

Release 5 — days 1–6 daily, dose 1

2021-03-06

Systemic reaction (other): Bloating and gas

2021-03-07

Systemic reaction (other): Limited range of movement in my shot arm x3 days, sweating, hot /flushed x2d,

2021-03-08

Systemic reaction (other): Behind my eyes and fever forehead entire time, light entire time light sensitive but a bit better today. A few chills tonight

2021-03-11

Systemic reaction (other): Depression

Release 6 — day 14, dose 1

2021-03-21

Symptoms: Headache around my eyes have returned. Might be unrelated but continuing and worsening anxiety frustration impatience which cycles to depression and crying. Has prevented me from driving, my other source of income. Still in bed today, almost 4pm omg cut off by CDC

Release 6 — days 1–6 daily, dose 2

2021-04-04

Systemic reaction (other): Dizzy

2021-04-05

Systemic reaction (other): Itching mild dizziness mild to moderate

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Severe persistentScalp itching since last checkin. Used husbands dandruff shampoo rinsed again later, covered scalp in morracan oil and put my hair up to try to deter continued scratching. Spoke with np office who denied correlation. Was total body itching immediately at 2nd injection, slightly so after the 1st inj

Healthcare visit (other): Phoned again np office and get ns called me back

2021-04-08

Systemic reaction (other): Been nauseated 3 days. Extremely irritable

Release 7 — day 14, dose 2

2021-04-17

Symptoms: Gastritis, urinate cystitis or uti, urinate pressure and frequency, diarrhea, gas, fatigue and lethargy, malaise

Release 7 — day 21, dose 2

2021-04-24

Symptoms: Kidney stones, bowel troubles, frequent painful urination, limb swelling

Release 8 — day 28, dose 2

2021-05-01

Symptoms: Hypersomnia, insomnia, auditory hallucinations, mania,

Release 8 — day 35, dose 2

2021-05-09

Symptoms: Probable uti and likely nephritis note on azo and keflex. Still passing stones. Back pain bladder discomfort and urinate track pain/sensitivity. Fatigue. Sometimes insomnia. Severe depression with occasional SI. Had to change a medication last week cut off by CDC

Release 8 — day 42, dose 2

2021-05-17

Symptoms: Crippling Fatigue, lability of mood, fibromyalgia joint and muscle pain, uti was negative but to continue on keflex. Back pain. Had to use my cane some bc r knee pain, fatigue or dizzy. Burning skin and allergy reactions unseen in yrs. constipation cut off by CDC

Healthcare visit (other): Recommended CT scan but providers not in agreement

Release 9 — 3 months, dose 2

2021-07-03

Symptoms: Ureter stones requiring a scope, lithotripsy and stent placement. L rotator cuff needing repeat surgery, increase in pain patch and flexaril, R large complex ovarian cyst, appendicitis, migraines and headaches, continued extreme fatigue and mentalhth cut off by CDC

Healthcare visit (other): Regular occurring visits

Release 11 — 12 months, dose 2

2022-04-03

Symptoms: Elbow avulsion, ammenorheia not due to menapause, dizziness, lethargy, excessive sleep, memory problems

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	Unevaluable event	✓	✓	✓
SD	Amenorrhoea	·	·	✓
SD	Anxiety	✓	✓	✓
SD	Appendicitis	✓	✓	✓
SD	Arthralgia	✓	✓	✓
SD	Avulsion fracture	·	·	✓
SD	Back pain	✓	✓	✓
SD	Bladder discomfort	✓	✓	✓
SD	Cystitis	✓	✓	✓
SD	Depression	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Dizziness	·	·	✓
SD	Dysuria	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Fibromyalgia	✓	✓	✓
SD	Gastritis	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Hallucination, auditory	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypersomnia	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Lethargy	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Mania	✓	✓	✓
SD	Memory impairment	·	·	✓
SD	Migraine	✓	✓	✓
SD	Nephrolithiasis	✓	✓	✓
SD	Ovarian cyst	✓	✓	✓
SD	Pain	✓	·	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pollakiuria	✓	✓	✓
SD	Pre-existing disease	✓	·	✓
SD	Skin burning sensation	✓	✓	✓
SD	Stent placement	○	✓	○
SD	Suicidal ideation	✓	✓	✓
SD	Ureteral stent insertion	✓	·	✓
SD	Ureteric obstruction	○	✓	○
SD	Ureterolithiasis	✓	·	✓
SD	Urinary tract infection	✓	✓	✓
SRO	Abdominal distension	✓	✓	✓
SRO	Anxiety	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Crying	✓	✓	✓
SRO	Depression	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling cold	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Flatulence	✓	✓	✓
SRO	Flushing	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Irritability	✓	✓	✓
SRO	Joint range of motion decreased	✓	✓	✓
SRO	Lacrimation increased	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Paranasal sinus hypersecretion	✓	✓	✓
SRO	Photophobia	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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