58X-22009-41354

4 vaccinations 17 coded responses 33 check-ins 16 free-text entries 4 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 246 / VA
Registered: 2021-02-11

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-02-11
Registered in v-safe
2021-02-11
Dose 1 — Moderna
2021-02-11
Survey response — day 0, dose 1
MedDRA: Pre-existing disease — Feeling: Good · Muscle or body aches

Free text: I have a left knee joint replacement. Some times my knees or ankles legs swell

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site induration — Feeling: Fair · Site: Redness, Swelling · Muscle or body aches, Fatigue or tiredness

Free text: Hard place under skin where injection

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 1
MedDRA: Vaccination site induration — Feeling: Good · Site: Pain, Redness · Muscle or body aches, Fatigue or tiredness

Free text: Hard under skin where vaccinated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site nodule — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Under injection site still hard in some places

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: Erythema, Injection site reaction — Feeling: Fair · Site: Swelling · Fatigue or tiredness

Free text: Redness of cheeks. A little hardness under injection site.

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 · Fatigue or tiredness

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-18
Health check-in — day 7, dose 1
Feeling: Fair · Joint pains

Adult check-in
2021-02-25
Survey response — day 14, dose 1
MedDRA: Ocular hyperaemia — Feeling: Fair

Free text: Eyeballs pink. Not pupils. Lasted for 4 to 5 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — day 21, dose 1
MedDRA: Eye inflammation, Fatigue, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Tired. Inflammation behind both eyes · Healthcare visit (other): Went to eye doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-11
Dose 2 — Moderna
2021-03-11
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site induration, Injection site mass — Feeling: Good · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness

Free text: Under the injection cite feels somewhat hard.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site induration — Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Free text: Hardness under injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site induration — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Hardness under injection site is less.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-25
Survey response — day 14, dose 2
MedDRA: Conjunctivitis — Feeling: Fair

Free text: Pink eyeballs for few days from each shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — day 21, dose 2
MedDRA: Erythema, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Redness of scalp. · Healthcare visit (other): Appointment next week. Have not yet been to Doctor.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-08
Survey response — day 28, dose 2
MedDRA: Fatigue, Office visit, Secretion discharge — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Mucus coming up from torso. Tiredness. · Healthcare visit (other): Eye doctor

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-15
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-22
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-07
Call 1 — Requested Callback
2021-06-07
Callback requested for
04:00P ET
2021-06-07
Call successful
Not applicable - Accidental Reporting
2021-06-07
Call successful
Not applicable - Accidental Reporting
2021-06-07
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-06-10
Health check-in — 3 months, dose 2
Feeling: Good

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

Adult check-in
2021-11-05
Dose 3 — Moderna
2022-03-11
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-04-04
Dose 4 — Moderna
2022-04-29
Survey response — day 21, dose 4
MedDRA: Fatigue — Feeling: Good · Be unable to do your normal daily activities

Free text: Fatigue for a few days after 2nd booster.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-09
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-16
Survey response — day 42, dose 4
MedDRA: Rash — Feeling: Good

Free text: Rash on lower belly

MedDRA releases: 2024-11 · check-in free text available
2022-07-04
Survey response — 3 months, dose 4
MedDRA: Contusion — Feeling: Good

Free text: Bruise on left arm

MedDRA releases: 2024-11 · check-in free text available
2022-10-05
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-04-04
Survey response — 12 months, dose 4
MedDRA: Medical counselling, Mental disorder — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-04-04
Report sent to call center — 12 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2023-04-05
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	2021-02-11	Moderna
2	2021-03-11	Moderna
3	2021-11-05	Moderna	No
4	2022-04-04	Moderna	No

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 4 — day 0, dose 1

2021-02-11

Systemic reaction (other): I have a left knee joint replacement. Some times my knees or ankles legs swell

Release 4 — days 1–6 daily, dose 1

2021-02-12

Systemic reaction (other): Hard place under skin where injection

2021-02-13

Systemic reaction (other): Hard under skin where vaccinated

2021-02-14

Systemic reaction (other): Under injection site still hard in some places

2021-02-15

Systemic reaction (other): Redness of cheeks. A little hardness under injection site.

Release 4 — day 14, dose 1

2021-02-25

Symptoms: Eyeballs pink. Not pupils. Lasted for 4 to 5 days.

Release 5 — day 21, dose 1

2021-03-04

Symptoms: Tired. Inflammation behind both eyes

Healthcare visit (other): Went to eye doctor

Release 5 — days 1–6 daily, dose 2

2021-03-12

Systemic reaction (other): Under the injection cite feels somewhat hard.

2021-03-13

Systemic reaction (other): Hardness under injection site

2021-03-14

Systemic reaction (other): Hardness under injection site is less.

Release 6 — day 14, dose 2

2021-03-25

Symptoms: Pink eyeballs for few days from each shot.

Release 6 — day 21, dose 2

2021-04-01

Symptoms: Redness of scalp.

Healthcare visit (other): Appointment next week. Have not yet been to Doctor.

Release 7 — day 28, dose 2

2021-04-08

Symptoms: Mucus coming up from torso. Tiredness.

Healthcare visit (other): Eye doctor

Release 11 — day 21, dose 4

2022-04-29

Symptoms: Fatigue for a few days after 2nd booster.

Release 11 — day 42, dose 4

2022-05-16

Symptoms: Rash on lower belly

Release 12 — 3 months, dose 4

2022-07-04

Symptoms: Bruise on left arm

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	Medical counselling	·	·	✓
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Conjunctivitis	✓	✓	✓
SD	Contusion	·	·	✓
SD	Erythema	✓	✓	✓
SD	Eye inflammation	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Mental disorder	·	·	✓
SD	Ocular hyperaemia	✓	✓	✓
SD	Rash	·	·	✓
SD	Secretion discharge	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Injection site induration	✓	✓	✓
SRO	Injection site mass	○	✓	○
SRO	Injection site nodule	✓	✓	✓
SRO	Injection site reaction	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Vaccination site induration	✓	✓	✓

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