5SB-62514-26311

4 vaccinations 11 coded responses 46 check-ins 11 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 301 / GA
Registered: 2021-01-18

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

2021-01-18
Registered in v-safe
2021-01-18
Dose 1 — Moderna
2021-01-18
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-19
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches

Adult check-in
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Dermatitis contact, Eyelid rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Small size rash under eyebrow and eyelash. Drs. office said maybe contact dermatitis.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-01
Survey response — day 14, dose 1
MedDRA: Eyelid cyst, Office visit — Feeling: Good

Free text: I do not know if this is Covid vaccine related or not. Tomorrow I will see a dermatologist because I have a small growth on my right eyelid. That appeared last week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Survey response — day 21, dose 1
MedDRA: Rash erythematous — Feeling: Fair

Free text: I have a red rash on my groin on the left thigh. I am treating this as ifbitvwerecdiapervrash.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Dose 2 — Moderna
2021-02-15
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Adult check-in
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: No adverse event, Unevaluable event — Feeling: Good · Fever · Rash, not including the immediate area around the injection site

Free text: Under breast

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Eyelid rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Rash over right eye lid came back.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-01
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-15
Survey response — day 28, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: Im feeling fatigued.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — day 35, dose 2
MedDRA: Myalgia — Feeling: Good

Free text: Muscle aches.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-29
Survey response — day 42, dose 2
MedDRA: Jaw clicking — Feeling: Good

Free text: My jaw is now bone us now making a clicking noise. This may be unrelated. I dont know.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Survey response — 3 months, dose 2
MedDRA: Temporomandibular joint syndrome — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: I now have TMJ in my jar and do not know if this has anything to do with the vaccine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Report sent to call center — 3 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-16
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Dose 3 — Moderna
2021-10-26
Health check-in — day 0, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Itching · Headache

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness · None

Adult check-in
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Itching · Fever · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-31
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-11-01
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site erythema, Injection site warmth — Feeling: Good · Site: Redness · Fatigue or tiredness

Free text: Injection site red and feverish.

MedDRA releases: 2024-11 · check-in free text available
2021-11-02
Health check-in — day 7, dose 3
Feeling: Good · Site: Redness · Fatigue or tiredness

Adult check-in
2021-11-09
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-16
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-23
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-30
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-02
Dose 4 — Moderna
2022-04-08
Call 1 — Left Voicemail
2022-04-19
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-23
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-02
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-07
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-14
Survey response — day 42, dose 4
MedDRA: Back pain, Body temperature increased, Headache, Rhinorrhoea — Feeling: Good

Free text: Headache, runny nose, sore throat, 99.1 temperature.

MedDRA releases: 2024-11 · check-in free text available
2022-07-02
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-01
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in
2023-04-02
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-18	Moderna
2	2021-02-15	Moderna
3	2021-10-26	Moderna	No
4	2022-04-02	Moderna	No

Call center

1 call center case

1 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-21

Systemic reaction (other): Small size rash under eyebrow and eyelash. Drs. office said maybe contact dermatitis.

Release 3 — day 14, dose 1

2021-02-01

Symptoms: I do not know if this is Covid vaccine related or not. Tomorrow I will see a dermatologist because I have a small growth on my right eyelid. That appeared last week.

Release 3 — day 21, dose 1

2021-02-08

Symptoms: I have a red rash on my groin on the left thigh. I am treating this as ifbitvwerecdiapervrash.

Release 4 — days 1–6 daily, dose 2

2021-02-17

Systemic reaction (other): Under breast

2021-02-19

Systemic reaction (other): Rash over right eye lid came back.

Release 5 — day 28, dose 2

2021-03-15

Symptoms: Im feeling fatigued.

Release 6 — day 35, dose 2

2021-03-22

Symptoms: Muscle aches.

Release 6 — day 42, dose 2

2021-03-29

Symptoms: My jaw is now bone us now making a clicking noise. This may be unrelated. I dont know.

Release 8 — 3 months, dose 2

2021-05-17

Symptoms: I now have TMJ in my jar and do not know if this has anything to do with the vaccine.

Release 10 — days 1–6 daily, dose 3

2021-11-01

Systemic reaction (other): Injection site red and feverish.

Release 11 — day 42, dose 4

2022-05-14

Symptoms: Headache, runny nose, sore throat, 99.1 temperature.

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	Back pain	·	·	✓
SD	Body temperature increased	·	·	✓
SD	Eyelid cyst	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Jaw clicking	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Office visit	✓	✓	✓
SD	Rash erythematous	✓	✓	✓
SD	Rhinorrhoea	·	·	✓
SD	Temporomandibular joint syndrome	✓	✓	✓
SRO	Dermatitis contact	✓	✓	✓
SRO	Eyelid rash	✓	✓	✓
SRO	Injection site erythema	·	·	✓
SRO	Injection site warmth	·	·	✓
SRO	No adverse event	✓	✓	○
SRO	Unevaluable event	·	·	✓

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