5CV-17966-58776

3 vaccinations 8 coded responses 27 check-ins 8 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 191 / PA
Registered: 2021-02-22

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

2021-02-22
Registered in v-safe
2021-02-22
Dose 1 — Moderna
2021-02-22
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Chills, Muscle or body aches

Adult check-in
2021-02-28
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Chills, Muscle or body aches

Adult check-in
2021-03-01
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-03-08
Survey response — day 14, dose 1
MedDRA: Back pain, Chest pain, Dyspnoea, Fatigue, Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Bad upper back pain sometimes chest, fatigue , shortness of breath · Healthcare visit (other): My Pulmonary Dr prescribed Prednisone for the shortness of breath today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-15
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-22
Dose 2 — Moderna
2021-03-22
Health check-in — day 0, dose 2
Feeling: Good · Chills

Adult check-in
2021-03-23
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Abdominal pain

Adult check-in
2021-03-26
Survey response — days 1–6 daily, dose 2
MedDRA: Back pain, Chest pain, Pain — Feeling: Poor · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Diarrhea

Free text: Upper body pain chest and upper back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-29
Survey response — day 7, dose 2
MedDRA: Dizziness — Feeling: Fair · Fatigue or tiredness

Free text: Lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-12
Survey response — day 21, dose 2
MedDRA: Abdominal distension, Chills, Dizziness, Fatigue — Feeling: Fair

Free text: Fatigue, dizziness, , chills , feeling bloated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-04-26
Survey response — day 35, dose 2
MedDRA: Discomfort, Dizziness, Nausea — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Feels like pressure or indigestion in the center of my upper body , light headed , nausea sometimes ,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-03
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-22
Survey response — 3 months, dose 2
MedDRA: Abdominal distension, Diarrhoea, Flatulence, Gastrointestinal disorder, Pain — Feeling: Fair

Free text: Stomach issues , gas and bloating , pain , diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-20
Survey response — 6 months, dose 2
MedDRA: Ear pain, Oropharyngeal pain — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Ear ache sore throat a week ago but its better now

MedDRA releases: 2024-11 · check-in free text available
2021-09-20
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-21
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-30
Dose 3 — Moderna
2022-03-22
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-01
Survey response — 3 months, dose 3
MedDRA: Diverticulitis, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Diverticulitis flare up on antibiotics

MedDRA releases: 2024-11 · check-in free text available
2022-05-01
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

Emergency room or emergency department visit · 1 call case(s)
2022-05-03
Call 1 — Could Not Reach Participant
2022-05-06
Call 2 — Left Voicemail
2022-07-31
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-22	Moderna
2	2021-03-22	Moderna
3	2022-01-30	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 5 — day 14, dose 1

2021-03-08

Symptoms: Bad upper back pain sometimes chest, fatigue , shortness of breath

Healthcare visit (other): My Pulmonary Dr prescribed Prednisone for the shortness of breath today

Release 6 — days 1–6 daily, dose 2

2021-03-26

Systemic reaction (other): Upper body pain chest and upper back

Release 6 — day 7, dose 2

2021-03-29

Systemic reaction (other): Lightheaded

Release 7 — day 21, dose 2

2021-04-12

Symptoms: Fatigue, dizziness, , chills , feeling bloated

Release 8 — day 35, dose 2

2021-04-26

Symptoms: Feels like pressure or indigestion in the center of my upper body , light headed , nausea sometimes ,

Release 9 — 3 months, dose 2

2021-06-22

Symptoms: Stomach issues , gas and bloating , pain , diarrhea

Release 9 — 6 months, dose 2

2021-09-20

Symptoms: Ear ache sore throat a week ago but its better now

Release 11 — 3 months, dose 3

2022-05-01

Symptoms: Diverticulitis flare up on antibiotics

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	Abdominal distension	✓	✓	✓
SD	Back pain	✓	✓	✓
SD	Chest pain	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Discomfort	✓	✓	✓
SD	Diverticulitis	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Dyspnoea	✓	✓	✓
SD	Ear pain	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Flatulence	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SRO	Back pain	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Pain	✓	✓	✓

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