595-96297-00165

2 vaccinations 7 coded responses 18 check-ins 7 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 207 / MD
Registered: 2021-03-08

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

2021-03-08
Registered in v-safe
2021-03-08
Dose 1 — Moderna
2021-03-08
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-13
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Recovering from mastectomy surgery.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-24
Survey response — day 14, dose 1
MedDRA: Oral herpes — Feeling: Good

Free text: Fever blister in the nose

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-01
Dose 2 — Moderna
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Chills, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Eye pain — Feeling: Good

Free text: Tenderness of eyes when touching the upper eyelids over last 3 days.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — day 7, dose 2
MedDRA: Eye pain — Feeling: Good

Free text: Tenderness of eyeballs when touching upper eyelids feeling less and less painful.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — day 14, dose 2
MedDRA: Pre-existing disease, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Hospitalization

Free text: Symptoms: Diagnosed 4/12/21 with blood clot in arm of shot. · Healthcare visit (other): Outpatient AAMC Appt for fluoroscopic procedure to adjust chemo port (detected then)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Report sent to call center — day 14, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-24
Survey response — day 21, dose 2
MedDRA: Axillary vein thrombosis, Deep vein thrombosis, Emergency care, Neck pain, Office visit, Peripheral swelling, Peripheral vein thrombosis, Physical examination abnormal, Swelling, Ultrasound Doppler abnormal — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Doctor recommended going to emergency room for Doppler test due to enlarged area and pain in neck. Result conclusion: Abnormal exam. DVT on the basis of non-occlusive thrombus within the axillary and brachial veins. On swollen vaccinated arm side

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)
2021-04-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-07-01
Survey response — 3 months, dose 2
MedDRA: Chest discomfort, Medical counselling, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Constant tightness in the chest up to base of neck. · Healthcare visit (other): Echocardiogram with Cardiologist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-01
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-06
Call 1 — Could Not Reach Participant
2021-07-09
Call 2 — Could Not Reach Participant
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-04-02
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-08	Moderna
2	2021-04-01	Moderna

Call center

3 call center cases

3 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-13

Systemic reaction (other): Recovering from mastectomy surgery.

Release 6 — day 14, dose 1

2021-03-24

Symptoms: Fever blister in the nose

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Tenderness of eyes when touching the upper eyelids over last 3 days.

Release 7 — day 7, dose 2

2021-04-08

Systemic reaction (other): Tenderness of eyeballs when touching upper eyelids feeling less and less painful.

Release 7 — day 14, dose 2

2021-04-16

Symptoms: Diagnosed 4/12/21 with blood clot in arm of shot.

Healthcare visit (other): Outpatient AAMC Appt for fluoroscopic procedure to adjust chemo port (detected then)

Release 7 — day 21, dose 2

2021-04-24

Symptoms: Doctor recommended going to emergency room for Doppler test due to enlarged area and pain in neck. Result conclusion: Abnormal exam. DVT on the basis of non-occlusive thrombus within the axillary and brachial veins. On swollen vaccinated arm side cut off by CDC

Release 9 — 3 months, dose 2

2021-07-01

Symptoms: Constant tightness in the chest up to base of neck.

Healthcare visit (other): Echocardiogram with Cardiologist

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	Pre-existing disease	✓	✓	✓
SD	Axillary vein thrombosis	✓	·	✓
SD	Chest discomfort	✓	✓	✓
SD	Deep vein thrombosis	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Neck pain	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Oral herpes	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Peripheral vein thrombosis	✓	·	✓
SD	Physical examination abnormal	○	✓	○
SD	Swelling	✓	✓	✓
SD	Ultrasound Doppler abnormal	✓	·	✓
SD	Unevaluable event	✓	✓	✓
SRO	Eye pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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