5QX-16603-80641

2 vaccinations 9 coded responses 25 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 895 / NV
Registered: 2020-12-31

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

2020-12-30
Dose 1 — Moderna
2020-12-31
Registered in v-safe
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

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

Adult check-in
2021-01-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Survey response — days 1–6 daily, dose 1
MedDRA: Diplopia, Headache, Vision blurred — Feeling: Good · Headache

Free text: Had a very odd visual episode probably not related to the vaccine. Lasted about a minute-everything went blurry and I had double vision. Thought I was having a TIA or something. It passed and left me with a mild headache.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-05
Survey response — days 1–6 daily, dose 1
MedDRA: Ophthalmic migraine, Vision blurred, Visual impairment — Feeling: Good · Headache, Abdominal pain

Free text: Having vision issues-ocular migraines and blurry vision. Not sure is related to shot but things got worse after it.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-06
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-21
Survey response — day 21, dose 1
MedDRA: Abdominal discomfort, Dyspepsia, Fatigue, Headache, Nausea, Pain — Feeling: Good · Be unable to do your normal daily activities

Free text: Had a bout of Acute GI distress with burning & nausea, fatigue, body aches, followed by 2 days of bad headache. NO fever, cough, or other Symptoms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Dose 2 — Moderna
2021-01-27
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Chest discomfort, Throat tightness — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Tightness in upper chest/throat (like in bronchial area).

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Pain, Swelling, Tenderness — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: The injection site itself is fine. The reddish, swollen area is just distal, in the biceps. Very painful to use that muscle today. Very tender o touch also.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · Headache

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-02
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion — Feeling: Good · Headache

Free text: Cough and a bit of congestion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Survey response — day 7, dose 2
MedDRA: Respiratory tract congestion — Feeling: Good

Free text: Mild congestion, probably not related.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-18
Survey response — day 21, dose 2
MedDRA: Cough, Upper-airway cough syndrome — Feeling: Fair

Free text: Post nasal drip with bronchial coughing.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-10
Survey response — day 42, dose 2
MedDRA: Cough, Fatigue, Headache, Office visit, Oxygen saturation decreased, Respiratory symptom, Sinus disorder, Upper-airway cough syndrome — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Upper respiratory s/s -seem sinus related (ha, post nasal drip, hacking cough, decreased o2saturation). No fever no loss of taste/smell, active but tired by eve when cough kicks in. · Healthcare visit (other): Outpatient Chest ex ray, CBC

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-10
Report sent to call center — day 42, dose 2
Get care from a doctor or other healthcare professional

no matching call case
2021-04-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-29
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Moderna
2	2021-01-27	Moderna

Call center

1 check-in flagged for a call with no call center case on record

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-04

Systemic reaction (other): Had a very odd visual episode probably not related to the vaccine. Lasted about a minute-everything went blurry and I had double vision. Thought I was having a TIA or something. It passed and left me with a mild headache.

2021-01-05

Systemic reaction (other): Having vision issues-ocular migraines and blurry vision. Not sure is related to shot but things got worse after it.

Release 2 — day 21, dose 1

2021-01-21

Symptoms: Had a bout of Acute GI distress with burning & nausea, fatigue, body aches, followed by 2 days of bad headache. NO fever, cough, or other Symptoms.

Release 3 — days 1–6 daily, dose 2

2021-01-28

Systemic reaction (other): Tightness in upper chest/throat (like in bronchial area).

2021-01-29

Systemic reaction (other): The injection site itself is fine. The reddish, swollen area is just distal, in the biceps. Very painful to use that muscle today. Very tender o touch also.

2021-02-02

Systemic reaction (other): Cough and a bit of congestion.

Release 3 — day 7, dose 2

2021-02-03

Systemic reaction (other): Mild congestion, probably not related.

Release 4 — day 21, dose 2

2021-02-18

Symptoms: Post nasal drip with bronchial coughing.

Release 5 — day 42, dose 2

2021-03-10

Symptoms: Upper respiratory s/s -seem sinus related (ha, post nasal drip, hacking cough, decreased o2saturation). No fever no loss of taste/smell, active but tired by eve when cough kicks in.

Healthcare visit (other): Outpatient Chest ex ray, CBC

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	Abdominal discomfort	✓	✓	✓
SD	Cough	✓	✓	✓
SD	Dyspepsia	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	Oxygen saturation decreased	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Respiratory symptom	✓	✓	✓
SD	Sinus disorder	✓	✓	✓
SD	Upper-airway cough syndrome	✓	✓	✓
SRO	Chest discomfort	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Diplopia	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Ophthalmic migraine	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Swelling	✓	✓	✓
SRO	Tenderness	✓	✓	✓
SRO	Throat tightness	✓	✓	✓
SRO	Vision blurred	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

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