5DV-26773-51481

3 vaccinations 6 coded responses 39 check-ins 6 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 773 / TX
Registered: 2021-01-04

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

2021-01-04
Registered in v-safe
2021-01-04
Dose 1 — Moderna
2021-01-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-06
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Insomnia — Feeling: Good · Site: Pain · Headache

Free text: Had trouble sleeping last night with headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-01-29
Dose 2 — Moderna
2021-01-29
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

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

Adult check-in
2021-02-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

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

Adult check-in
2021-02-05
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-30
Survey response — 3 months, dose 2
MedDRA: Abdominal pain, Computerised tomogram, Diverticulitis, Emergency care, Pyrexia — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Er visit with fever and abdominal pain a couple weeks ago. After a CT scan I was diagnosed with diverticulitis. Treated with antibiotics and feel fine now.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-31
Dose 3 — Moderna
2021-10-31
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Tinnitus — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Free text: Ringing in ears

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Survey response — days 1–6 daily, dose 3
MedDRA: Pain in extremity — Feeling: Good · Site: Pain

Free text: Arm still a little sore

MedDRA releases: 2024-11 · check-in free text available
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-07
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-14
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-21
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-28
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-12
Survey response — day 42, dose 3
MedDRA: Abdominal pain upper, Diverticulitis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Don't think it was related to vaccine however, last night i had stomach cramps. I have had 2 bouts of diverticulitis requiring antibiotics since I received my first vaccine on January 4. First flare was early April, second in early September.

MedDRA releases: 2024-11 · check-in free text available
2021-12-12
Report sent to call center — day 42, 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 · 1 call case(s)
2021-12-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-01-30
Survey response — 3 months, dose 3
MedDRA: Eyelid infection, Office visit, Swelling of eyelid — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Both eyes, upper and lower lid swelling and infection. Currently taking steroid/antibiotic eye drops. Getting better. · Healthcare visit (other): My opthamologist

MedDRA releases: 2024-11 · check-in free text available
2022-01-30
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-09
Call 1 — Left Voicemail
2022-05-01
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-31
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-01-29	Moderna
3	2021-10-31	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-06

Systemic reaction (other): Had trouble sleeping last night with headache

Release 8 — 3 months, dose 2

2021-04-30

Symptoms: Er visit with fever and abdominal pain a couple weeks ago. After a CT scan I was diagnosed with diverticulitis. Treated with antibiotics and feel fine now.

Release 10 — days 1–6 daily, dose 3

2021-11-01

Systemic reaction (other): Ringing in ears

2021-11-02

Systemic reaction (other): Arm still a little sore

Release 10 — day 42, dose 3

2021-12-12

Symptoms: Don't think it was related to vaccine however, last night i had stomach cramps. I have had 2 bouts of diverticulitis requiring antibiotics since I received my first vaccine on January 4. First flare was early April, second in early September.

Release 11 — 3 months, dose 3

2022-01-30

Symptoms: Both eyes, upper and lower lid swelling and infection. Currently taking steroid/antibiotic eye drops. Getting better.

Healthcare visit (other): My opthamologist

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	Office visit	·	·	✓
SD	Abdominal pain	✓	✓	✓
SD	Abdominal pain upper	·	·	✓
SD	Computerised tomogram	✓	✓	✓
SD	Diverticulitis	✓	✓	✓
SD	Emergency care	✓	✓	✓
SD	Eyelid infection	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Swelling of eyelid	·	·	✓
SRO	Headache	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Tinnitus	·	·	✓

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