5JC-99129-30896

2 vaccinations 11 coded responses 22 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 56-60
ZIP prefix: 707 / LA
Registered: 2021-02-08

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

2021-02-05
Dose 1 — Moderna
2021-02-08
Registered in v-safe
2021-02-08
Survey response — days 1–6 daily, dose 1
MedDRA: Ear pain — Feeling: Good · Site: Pain, Swelling, Itching

Free text: An Ear ache in my left ear

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Sleep disorder — Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: I failed to mention on yesterday, that I was not able to sleep on the side of the Vaccine site for a couple of days...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-19
Survey response — day 14, dose 1
MedDRA: Balance disorder, Cough, Pain — Feeling: Fair

Free text: I don't know if it's associated with the deep freeze, but I have been coughing, balance off and have pains in my right side...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-05
Dose 2 — Moderna
2021-03-05
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Ear pain, Vaccine positive rechallenge — Feeling: Fair · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: Cough, left earache just like it was when I took the first Vaccine. the

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Ear pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: Ear ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fever · Fatigue or tiredness

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Good · Fatigue or tiredness

Free text: Itching over various parts of my body...

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

Free text: Ear ache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Health check-in — day 7, dose 2
Feeling: Fair · Site: Itching · Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-03-19
Survey response — day 14, dose 2
MedDRA: Fatigue, Somnolence — Feeling: Fair · Be unable to do your normal daily activities

Free text: I am more tired and sleepy than normal! I was a person that did not sleep during the day, but lately all I want to do is sleep and be to myself.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-09
Survey response — day 35, dose 2
MedDRA: Cough — Feeling: Fair

Free text: Dry cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — day 42, dose 2
MedDRA: Pruritus — Feeling: Fair · Be unable to do your normal daily activities

Free text: Itching all over my body...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-03
Survey response — 6 months, dose 2
MedDRA: Headache, Influenza like illness, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Headaches, flu like symptoms · Healthcare visit (other): Primary doctor

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-03
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-09-08
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-05	Moderna
2	2021-03-05	Moderna

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-08

Systemic reaction (other): An Ear ache in my left ear

2021-02-09

Systemic reaction (other): I failed to mention on yesterday, that I was not able to sleep on the side of the Vaccine site for a couple of days...

Release 4 — day 14, dose 1

2021-02-19

Symptoms: I don't know if it's associated with the deep freeze, but I have been coughing, balance off and have pains in my right side...

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Cough, left earache just like it was when I took the first Vaccine. the

2021-03-07

Systemic reaction (other): Ear ache

2021-03-10

Systemic reaction (other): Itching over various parts of my body...

2021-03-11

Systemic reaction (other): Ear ache

Release 5 — day 14, dose 2

2021-03-19

Symptoms: I am more tired and sleepy than normal! I was a person that did not sleep during the day, but lately all I want to do is sleep and be to myself.

Release 7 — day 35, dose 2

2021-04-09

Symptoms: Dry cough

Release 7 — day 42, dose 2

2021-04-16

Symptoms: Itching all over my body...

Release 9 — 6 months, dose 2

2021-09-03

Symptoms: Headaches, flu like symptoms

Healthcare visit (other): Primary doctor

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	Balance disorder	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	·	✓
SD	Influenza like illness	✓	·	✓
SD	Pain	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Somnolence	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓
SRO	Vaccine positive rechallenge	✓	✓	✓

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