5JM-63925-01987

3 vaccinations 8 coded responses 27 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 442 / OH
Registered: 2021-03-28

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

2021-02-26
Dose 1 — Moderna
2021-03-26
Dose 2 — Moderna
2021-03-28
Registered in v-safe
2021-03-28
Survey response — days 1–6 daily, dose 2
MedDRA: Chills, Headache, Nausea, Pyrexia — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Be unable to do your normal daily activities

Free text: yesterday i had fever, nausea, headache, chills,

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Rash, not including the immediate area around the injection site

Free text: Its redness swelling itching,pain site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — days 1–6 daily, dose 2
MedDRA: Aphthous ulcer, Injection site pruritus — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Rash, not including the immediate area around the injection site

Free text: Large itchy area well below injection site. Also had acaker sore on the left side of my tongue for a day after each injection. It is gone now. Not sure if that would be related to the shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-31
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Redness, Itching · Headache, Fatigue or tiredness

Free text: Lightheaded at times

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Site: Itching

Free text: Occaaional lightheadedness last couple days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-16
Survey response — day 21, dose 2
MedDRA: Dizziness, Exercise tolerance decreased, Fatigue, Feeling abnormal, Headache, Irregular breathing, Loss of personal independence in daily activities — Feeling: Fair · Be unable to do your normal daily activities

Free text: Felt bad yesterday very tired, lightheaded, had no energy when I went for my run. Struggled regulating my breathing with running. Had a slight headache. Had to take a nap. Lightheaded at times today. Yesterday I could not do my daily activities

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-24
Survey response — 6 months, dose 2
MedDRA: Headache, Oropharyngeal pain, Productive cough, Pyrexia, SARS-CoV-2 test, Sputum discoloured — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sore throat, harsh productive cough. Coughing up green mucus plugs. Low grade fever. Headache. Went for covid test today waiting for results

MedDRA releases: 2024-11 · check-in free text available
2021-09-24
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-09-28
Call 1 — Left Voicemail
2021-09-28
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-11-02
Dose 3 — Moderna
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches, Nausea

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Chills, Abdominal pain

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 — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-09
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-16
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-14
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-03
Survey response — 6 months, dose 3
MedDRA: Herpes zoster — Feeling: Good

Free text: I have shingles without the rash

MedDRA releases: 2024-11 · check-in free text available
2022-11-02
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-26	Moderna
2	2021-03-26	Moderna
3	2021-11-02	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-28

Systemic reaction (other): yesterday i had fever, nausea, headache, chills,

2021-03-29

Systemic reaction (other): Its redness swelling itching,pain site

2021-03-30

Systemic reaction (other): Large itchy area well below injection site. Also had acaker sore on the left side of my tongue for a day after each injection. It is gone now. Not sure if that would be related to the shot.

2021-03-31

Systemic reaction (other): Lightheaded at times

2021-04-01

Systemic reaction (other): Occaaional lightheadedness last couple days

Release 7 — day 21, dose 2

2021-04-16

Symptoms: Felt bad yesterday very tired, lightheaded, had no energy when I went for my run. Struggled regulating my breathing with running. Had a slight headache. Had to take a nap. Lightheaded at times today. Yesterday I could not do my daily activities

Release 9 — 6 months, dose 2

2021-09-24

Symptoms: Sore throat, harsh productive cough. Coughing up green mucus plugs. Low grade fever. Headache. Went for covid test today waiting for results

Release 11 — 6 months, dose 3

2022-05-03

Symptoms: I have shingles without the rash

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	Dizziness	✓	✓	✓
SD	Exercise tolerance decreased	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Feeling abnormal	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Herpes zoster	·	·	✓
SD	Irregular breathing	✓	✓	✓
SD	Loss of personal independence in daily activities	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SD	Productive cough	·	·	✓
SD	Pyrexia	·	·	✓
SD	SARS-CoV-2 test	·	·	✓
SD	Sputum discoloured	·	·	✓
SRO	Aphthous ulcer	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site erythema	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Injection site swelling	✓	✓	✓
SRO	Nausea	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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