57J-11583-00630

5 vaccinations 8 coded responses 38 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 064 / CT
Registered: 2021-03-22

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

2021-02-28
Dose 1 — Moderna
2021-03-22
Registered in v-safe
2021-03-29
Dose 2 — Moderna
2021-03-30
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lower back pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness, Swelling · Muscle or body aches

Adult check-in
2021-04-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-04-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-26
Health check-in — day 28, dose 2
Feeling: Good

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

Adult check-in
2021-05-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-27
Survey response — 6 months, dose 2
MedDRA: Malaise, Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Good

Free text: Had a summer cold that had all the symptoms of COVID. Used an over the counter testing kit and results came back negative. This was the end of August

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Dose 3 — Moderna
Co-administered: Flu
2022-03-29
Survey response — 12 months, dose 2
MedDRA: Chest pain, Palpitations, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Symptoms: Severe palpitations /chest pains · Healthcare visit (other): Observation and tests

MedDRA releases: 2024-11 · check-in free text available
2022-03-29
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

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-03-31
Call 1 — Left Voicemail
2022-05-13
Survey response — 6 months, dose 3
MedDRA: Emergency care, Palpitations — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Heart palpitations severe enough to go to emergencythis happened at beginning of March. All in hospital tests came back ok. Had month long monitor. Appt with cardio coming next week to assess monitor, etc

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2022-05-16
Call 1 — Left Voicemail
2022-05-22
Dose 4 — Moderna
2022-06-03
Health check-in — day 7, dose 4
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2022-06-05
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-12
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-19
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-26
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-03
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-21
Survey response — 3 months, dose 4
MedDRA: Oropharyngeal pain, Pain, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: Sore throat, fever, aches and pains,

MedDRA releases: 2024-11 · check-in free text available
2022-10-10
Dose 5 — Pfizer-BioNTech
Co-administered: Flu
2022-10-10
Health check-in — day 0, dose 5
Feeling: Fair · Site: Pain · Muscle or body aches

Adult check-in
2022-10-11
Health check-in — days 1–6 daily, dose 5
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-12
Survey response — days 1–6 daily, dose 5
MedDRA: Adverse food reaction — Feeling: Good · Site: Pain, Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: These symptoms occurred 10/10, night of injections and attributed yo food issues

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Survey response — days 1–6 daily, dose 5
MedDRA: Brain fog — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Free text: Brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-10-14
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-10-15
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2022-10-16
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2022-10-17
Health check-in — day 7, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-24
Health check-in — day 14, dose 5
Feeling: Good

Adult check-in
2022-10-31
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-07
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-14
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-21
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-09
Survey response — 3 months, dose 5
MedDRA: Fatigue, Myalgia, Oropharyngeal pain, Throat irritation — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-04-10
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-28	Moderna
2	2021-03-29	Moderna
3	2021-11-12	Moderna	Flu
4	2022-05-22	Moderna	No
5	2022-10-10	Pfizer-BioNTech	Flu

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-31

Systemic reaction (other): Lower back pain

Release 9 — 6 months, dose 2

2021-09-27

Symptoms: Had a summer cold that had all the symptoms of COVID. Used an over the counter testing kit and results came back negative. This was the end of August

Release 11 — 12 months, dose 2

2022-03-29

Symptoms: Severe palpitations /chest pains

Healthcare visit (other): Observation and tests

Release 11 — 6 months, dose 3

2022-05-13

Symptoms: Heart palpitations severe enough to go to emergencythis happened at beginning of March. All in hospital tests came back ok. Had month long monitor. Appt with cardio coming next week to assess monitor, etc

Release 12 — 3 months, dose 4

2022-08-21

Symptoms: Sore throat, fever, aches and pains,

Release 12 — days 1–6 daily, dose 5

2022-10-12

Systemic reaction (other): These symptoms occurred 10/10, night of injections and attributed yo food issues

2022-10-13

Systemic reaction (other): Brain fog

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	Unevaluable event	·	·	✓
SD	Chest pain	·	·	✓
SD	Emergency care	·	·	✓
SD	Fatigue	·	·	✓
SD	Malaise	·	·	✓
SD	Myalgia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Palpitations	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Throat irritation	·	·	✓
SRO	Adverse food reaction	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Brain fog	·	·	✓

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