5QW-17299-75773

2 vaccinations 9 coded responses 22 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 105 / NY
Registered: 2021-03-09

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

2021-03-09
Registered in v-safe
2021-03-09
Dose 1 — Moderna
2021-03-09
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain · Headache, Nausea

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Headache, Nausea — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work

Free text: Chills, headache, nausea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Nausea

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Nausea, Diarrhea, Abdominal pain

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain

Adult check-in
2021-03-16
Health check-in — day 7, dose 1
Feeling: Good · Headache, Nausea, Diarrhea, Abdominal pain

Adult check-in
2021-03-25
Survey response — day 14, dose 1
MedDRA: Arthralgia, Injection site pain, Pain in extremity — Feeling: Fair

Free text: Pain at the injection sight. In the arm. Neck and hips.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — day 21, dose 1
MedDRA: Hypoaesthesia — Feeling: Fair

Free text: NUMBNESS IN ARM.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Dose 2 — Moderna
2021-04-06
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-13
Health check-in — day 7, dose 2
Feeling: Fair · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-20
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-27
Survey response — day 21, dose 2
MedDRA: Tinnitus — Feeling: Poor

Free text: Ring in the ear. Its a symphony. Lots of feedback. Like a radio

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — day 35, dose 2
MedDRA: Blood pressure increased, Tinnitus — Feeling: Fair · Be unable to work, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Ring in my ear. Elevated blood pressure.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Report sent to call center — day 35, dose 2
Be unable to work · Get care from a doctor or other healthcare professional

1 call case(s)
2021-05-20
Survey response — day 42, dose 2
MedDRA: Blood pressure increased, Deafness, Sensory disturbance — Feeling: Fair

Free text: High blood pressure.Fluttering in right arm.Hearing loss.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-06
Survey response — 3 months, dose 2
MedDRA: Arthralgia, Joint swelling, Pain in extremity — Feeling: Fair

Free text: Joint pains.Swollen ankles.Pain in feet.Temperatute 99.5

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-05
Survey response — 6 months, dose 2
MedDRA: Ear pain, Formication, Neck pain, Office visit, Pain in extremity, Paraesthesia, Self-medication — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: My arm hurts more than ever. I am taking tylenol every hours, oain extends to my neck and ear. Had to go to the doctor last week. Tingling in my arm like something crawling.

MedDRA releases: 2024-11 · check-in free text available
2021-10-05
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-10-06
Call 1 — Left Voicemail
2022-04-06
Survey response — 12 months, dose 2
MedDRA: Diarrhoea, Headache, Vomiting — Feeling: Fair

Free text: Diarrhea, vomiting. Headache

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-09	Moderna
2	2021-04-06	Moderna

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-10

Systemic reaction (other): Chills, headache, nausea

Release 6 — day 14, dose 1

2021-03-25

Symptoms: Pain at the injection sight. In the arm. Neck and hips.

Release 6 — day 21, dose 1

2021-03-30

Symptoms: NUMBNESS IN ARM.

Release 8 — day 21, dose 2

2021-04-27

Symptoms: Ring in the ear. Its a symphony. Lots of feedback. Like a radio

Release 8 — day 35, dose 2

2021-05-11

Symptoms: Ring in my ear. Elevated blood pressure.

Release 8 — day 42, dose 2

2021-05-20

Symptoms: High blood pressure.Fluttering in right arm.Hearing loss.

Release 9 — 3 months, dose 2

2021-07-06

Symptoms: Joint pains.Swollen ankles.Pain in feet.Temperatute 99.5

Release 10 — 6 months, dose 2

2021-10-05

Symptoms: My arm hurts more than ever. I am taking tylenol every hours, oain extends to my neck and ear. Had to go to the doctor last week. Tingling in my arm like something crawling.

Release 11 — 12 months, dose 2

2022-04-06

Symptoms: Diarrhea, vomiting. Headache

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	Arthralgia	✓	✓	✓
SD	Blood pressure increased	✓	✓	✓
SD	Deafness	✓	✓	✓
SD	Diarrhoea	·	·	✓
SD	Ear pain	·	·	✓
SD	Formication	·	·	✓
SD	Headache	·	·	✓
SD	Hypoaesthesia	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Joint swelling	✓	✓	✓
SD	Neck pain	·	·	✓
SD	Office visit	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Paraesthesia	·	·	✓
SD	Self-medication	·	·	✓
SD	Sensory disturbance	✓	✓	✓
SD	Tinnitus	✓	✓	✓
SD	Vomiting	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Nausea	✓	✓	✓

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