5DX-33140-00507

2 vaccinations 8 coded responses 22 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 985 / WA
Registered: 2021-05-28

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

2021-05-28
Registered in v-safe
2021-05-28
Dose 1 — Moderna
2021-05-28
Health check-in — day 0, dose 1
Feeling: Fair · None

Adult check-in
2021-05-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-05-31
Survey response — days 1–6 daily, dose 1
MedDRA: Mouth ulceration — Feeling: Fair · Headache, Fatigue or tiredness

Free text: developed a small ulcerated spot in my mouth, noticed it last night. much bigger today. i do not have a history of canker sores

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness

Adult check-in
2021-06-02
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Chills, Headache, Fatigue or tiredness

Adult check-in
2021-06-03
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Hypersensitivity — Feeling: Fair · Headache

Free text: Starting last night am getting bouts of dizziness and hypersensitivity to noise. There are several more white lesions in my mouth that appeared this morning.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Survey response — day 7, dose 1
MedDRA: Dizziness, Muscular weakness, Pre-existing disease — Feeling: Poor · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: dizziness is worsening, legs feel weak

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-06-18
Survey response — day 21, dose 1
MedDRA: Hypoaesthesia, Malaise, Oropharyngeal pain, Pain in jaw — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Sore throat, numbness on right side of face, general feeling of being unwell, jaw pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Report sent to call center — day 21, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-25
Dose 2 — Moderna
2021-06-25
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-25
Call 1 — Left Voicemail
2021-06-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-06-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-06-28
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-06-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-07-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-07-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-07-09
Survey response — day 14, dose 2
MedDRA: Flushing, Headache, Muscle spasms, Myalgia — Feeling: Fair

Free text: Muscle aches and cramps, flushed skin, headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-16
Survey response — day 21, dose 2
MedDRA: Erythema, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Leg pain in one leg, skin redness

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-23
Survey response — day 28, dose 2
MedDRA: Chest pain, Pain in extremity — Feeling: Poor · Be unable to do your normal daily activities

Free text: Worsening leg pain, left leg. Chest pain

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-30
Survey response — day 35, dose 2
MedDRA: Abdominal pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit

Free text: Abdominal pain

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-30
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-10
Call 1 — Left Voicemail
2021-09-24
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-28	Moderna
2	2021-06-25	Moderna	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-31

Systemic reaction (other): developed a small ulcerated spot in my mouth, noticed it last night. much bigger today. i do not have a history of canker sores

2021-06-03

Systemic reaction (other): Starting last night am getting bouts of dizziness and hypersensitivity to noise. There are several more white lesions in my mouth that appeared this morning.

Release 8 — day 7, dose 1

2021-06-04

Systemic reaction (other): dizziness is worsening, legs feel weak

Release 9 — day 21, dose 1

2021-06-18

Symptoms: Sore throat, numbness on right side of face, general feeling of being unwell, jaw pain

Release 9 — day 14, dose 2

2021-07-09

Symptoms: Muscle aches and cramps, flushed skin, headache

Release 9 — day 21, dose 2

2021-07-16

Symptoms: Leg pain in one leg, skin redness

Release 9 — day 28, dose 2

2021-07-23

Symptoms: Worsening leg pain, left leg. Chest pain

Release 9 — day 35, dose 2

2021-07-30

Symptoms: Abdominal pain

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
SD	Abdominal pain	✓	·	✓
SD	Chest pain	✓	·	✓
SD	Erythema	✓	·	✓
SD	Flushing	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Malaise	✓	✓	✓
SD	Muscle spasms	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Pain in extremity	✓	·	✓
SD	Pain in jaw	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Mouth ulceration	✓	✓	✓
SRO	Muscular weakness	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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