569-23650-83018

5 vaccinations 9 coded responses 30 check-ins 9 free-text entries 4 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 900 / CA
Registered: 2021-01-15

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

2021-01-15
Registered in v-safe
2021-01-15
Dose 1 — Moderna
2021-01-15
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Cough — Feeling: Good · Site: Pain · Headache

Free text: Vague cough nothing alarming

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Adult check-in
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-23
Survey response — day 7, dose 2
MedDRA: Unevaluable event — Feeling: Good · Site: Pain · Muscle or body aches, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: This was the 2 days after 2nd dose - not today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-28
Dose 3 — Moderna
2021-11-29
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-01-29
Dose 4 — Moderna
2022-02-28
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-09-16
Dose 5 — Moderna
2022-09-17
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2022-09-18
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-09-19
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-09-20
Survey response — days 1–6 daily, dose 5
MedDRA: Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: Poor

Free text: Sore throat (tested negative for Covid)

MedDRA releases: 2024-11 · check-in free text available
2022-09-21
Survey response — days 1–6 daily, dose 5
MedDRA: Influenza, Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Flu - sore throat but tested negative for Covid again

MedDRA releases: 2024-11 · check-in free text available
2022-09-23
Survey response — day 7, dose 5
MedDRA: Influenza, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Flu still testing negative for covid

MedDRA releases: 2024-11 · check-in free text available
2022-09-30
Survey response — day 14, dose 5
MedDRA: Influenza — Feeling: Fair · 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

Free text: Bad flu - not Covid

MedDRA releases: 2024-11 · check-in free text available
2022-09-30
Report sent to call center — day 14, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-03
Call 1 — Left Voicemail
2022-10-03
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-07
Health check-in — day 21, dose 5
Feeling: Fair

Adult check-in
2022-10-14
Survey response — day 28, dose 5
MedDRA: Epstein-Barr virus antibody positive, Hyperthyroidism, Influenza, Malaise, Sinusitis, Thyroid function test abnormal — Feeling: Fair · 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

Free text: I've been REALLY sick first with flu and on second round of antibiotics for sinus infection / blood work found my thyroid abnormally overactive (increased meds) as well as Epstein Barr antibodies positive

MedDRA releases: 2024-11 · check-in free text available
2022-10-14
Report sent to call center — day 28, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-10-17
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-21
Survey response — day 35, dose 5
MedDRA: Hyperthyroidism, Pre-existing disease — Feeling: Poor · 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: Abnormally overactive thyroid and diagnosed with probable acute Epstein barr recurrence

MedDRA releases: 2024-11 · check-in free text available
2022-10-21
Report sent to call center — day 35, dose 5
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)
2022-10-24
Call 1 — Left Voicemail
2022-10-30
Health check-in — day 42, dose 5
Feeling: Fair

Adult check-in
2022-12-16
Survey response — 3 months, dose 5
MedDRA: Foot operation, Surgery — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Unrelated to Covid - had foot surgery last week · Healthcare visit (other): Surgery unrelated to Covid!

MedDRA releases: 2024-11 · check-in free text available
2022-12-16
Report sent to call center — 3 months, dose 5
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)
2022-12-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-08-28	Moderna	No
4	2022-01-29	Moderna	No
5	2022-09-16	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Vague cough nothing alarming

Release 4 — day 7, dose 2

2021-02-23

Systemic reaction (other): This was the 2 days after 2nd dose - not today

Release 12 — days 1–6 daily, dose 5

2022-09-20

Systemic reaction (other): Sore throat (tested negative for Covid)

2022-09-21

Systemic reaction (other): Flu - sore throat but tested negative for Covid again

Release 12 — day 7, dose 5

2022-09-23

Systemic reaction (other): Flu still testing negative for covid

Release 12 — day 14, dose 5

2022-09-30

Symptoms: Bad flu - not Covid

Release 12 — day 28, dose 5

2022-10-14

Symptoms: I've been REALLY sick first with flu and on second round of antibiotics for sinus infection / blood work found my thyroid abnormally overactive (increased meds) as well as Epstein Barr antibodies positive

Release 12 — day 35, dose 5

2022-10-21

Symptoms: Abnormally overactive thyroid and diagnosed with probable acute Epstein barr recurrence

Release 12 — 3 months, dose 5

2022-12-16

Symptoms: Unrelated to Covid - had foot surgery last week

Healthcare visit (other): Surgery unrelated to Covid!

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	Surgery	·	·	✓
SD	Epstein-Barr virus antibody positive	·	·	✓
SD	Foot operation	·	·	✓
SD	Hyperthyroidism	·	·	✓
SD	Influenza	·	·	✓
SD	Malaise	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Sinusitis	·	·	✓
SD	Thyroid function test abnormal	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Influenza	·	·	✓
SRO	Oropharyngeal pain	·	·	✓
SRO	SARS-CoV-2 test negative	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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