5KU-17863-54071

2 vaccinations 8 coded responses 10 check-ins 8 free-text entries 1 call case

Sex: Female
Age at first dose: 41-45
ZIP prefix: 217 / MD
Registered: 2021-04-12

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

2021-04-10
Dose 1 — Moderna
2021-04-12
Registered in v-safe
2021-04-12
Survey response — days 1–6 daily, dose 1
MedDRA: Hyposmia — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Sense of smell is off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — days 1–6 daily, dose 1
MedDRA: Dry mouth, Memory impairment, Pruritus, Visual impairment — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Very dry mouth, localized itching on foot, vision, impaired memorychanges

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — days 1–6 daily, dose 1
MedDRA: Thirst — Feeling: Fair · Fever · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Very thirsty

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Severe fatique all morning, now very very tired

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — days 1–6 daily, dose 1
MedDRA: Decreased appetite — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Low apetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Dose 2 — Moderna
2021-05-15
Health check-in — day 0, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-16
Survey response — days 1–6 daily, dose 2
MedDRA: Cough — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Cough

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Survey response — days 1–6 daily, dose 2
MedDRA: Ageusia, Taste disorder — Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Change is taste. Less taste.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work

Adult check-in
2022-05-17
Survey response — 12 months, dose 2
MedDRA: Chronic active Epstein-Barr virus infection, Condition aggravated, Pre-existing disease, Unevaluable event — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit

Free text: Symptoms: Since beginning the vaccine series my reactivated EBV progressed to Chronic Active EBV. I'm immune suppressed due to Chronic Lyme Disease already and this vaccine made my immune suppression worse. Nine days after receiving my last Booster Dec 2021, I · Healthcare visit (other): I try to avoid hospitals

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2022-05-18
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-10	Moderna
2	2021-05-15	Moderna

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-12

Systemic reaction (other): Sense of smell is off

2021-04-13

Systemic reaction (other): Very dry mouth, localized itching on foot, vision, impaired memorychanges

2021-04-14

Systemic reaction (other): Very thirsty

2021-04-15

Systemic reaction (other): Severe fatique all morning, now very very tired

2021-04-16

Systemic reaction (other): Low apetite

Release 8 — days 1–6 daily, dose 2

2021-05-16

Systemic reaction (other): Cough

2021-05-17

Systemic reaction (other): Change is taste. Less taste.

Release 11 — 12 months, dose 2

2022-05-17

Symptoms: Since beginning the vaccine series my reactivated EBV progressed to Chronic Active EBV. I'm immune suppressed due to Chronic Lyme Disease already and this vaccine made my immune suppression worse. Nine days after receiving my last Booster Dec 2021, I cut off by CDC

Healthcare visit (other): I try to avoid hospitals

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	Chronic active Epstein-Barr virus infection	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Pre-existing disease	·	·	✓
SRO	Ageusia	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Hyposmia	✓	✓	✓
SRO	Memory impairment	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Taste disorder	✓	✓	✓
SRO	Thirst	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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