5SL-11603-14697

2 vaccinations 10 coded responses 23 check-ins 10 free-text entries 0 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 857 / AZ
Registered: 2021-04-29

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline Vaccinations Free text MedDRA terms

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-29
Registered in v-safe
2021-04-29
Dose 1 — Moderna
2021-04-29
Health check-in — day 0, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-04-30
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site reaction — Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activities

Free text: Injection site spasms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-06
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-13
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-22
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-27
Dose 2 — Moderna
2021-05-27
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-05-28
Survey response — days 1–6 daily, dose 2
MedDRA: Muscle spasms, Paraesthesia, Tinnitus, Vision blurred — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Ears ringing , injection sight muscle spasms. Vision blurry. Tingles in arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Survey response — days 1–6 daily, dose 2
MedDRA: Chest pain — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: Chest pains when deep breathing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-30
Survey response — days 1–6 daily, dose 2
MedDRA: Dry mouth, Tinnitus, Vision blurred — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dry mouth eyes blurry ears ringing

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-06-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-06-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-06-03
Health check-in — day 7, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-06-10
Survey response — day 14, dose 2
MedDRA: Vision blurred — Feeling: Good

Free text: Blurry eyesight

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-24
Survey response — day 28, dose 2
MedDRA: Dyspnoea, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities

Free text: Vision started getting blurry since this past weekendShortness of breath

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-01
Survey response — day 35, dose 2
MedDRA: Heavy menstrual bleeding — Feeling: Fair

Free text: Period lasted 6 weeks. Very unusual

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-08
Survey response — day 42, dose 2
MedDRA: Fatigue, Vision blurred — Feeling: Fair

Free text: Vision still very blurry and fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-26
Survey response — 3 months, dose 2
MedDRA: Dysgeusia — Feeling: Good

Free text: Metal taste

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-25
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-05-27
Survey response — 12 months, dose 2
MedDRA: Mammogram abnormal, Pain in extremity, Smear cervix abnormal, Tinnitus — Feeling: Fair · Be unable to work or attend school

Free text: Arm still sore as if I just got injection Vision is getting rapidly worse Constant ringing of the ears. Abnormal pap and mammogram tests

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-29	Moderna
2	2021-05-27	Moderna

Free text

Release 8 — days 1–6 daily, dose 1

2021-04-30

Systemic reaction (other): Injection site spasms

Release 8 — days 1–6 daily, dose 2

2021-05-28

Systemic reaction (other): Ears ringing , injection sight muscle spasms. Vision blurry. Tingles in arm

2021-05-29

Systemic reaction (other): Chest pains when deep breathing

2021-05-30

Systemic reaction (other): Dry mouth eyes blurry ears ringing

Release 9 — day 14, dose 2

2021-06-10

Symptoms: Blurry eyesight

Release 9 — day 28, dose 2

2021-06-24

Symptoms: Vision started getting blurry since this past weekendShortness of breath

Release 9 — day 35, dose 2

2021-07-01

Symptoms: Period lasted 6 weeks. Very unusual

Release 9 — day 42, dose 2

2021-07-08

Symptoms: Vision still very blurry and fatigue

Release 9 — 3 months, dose 2

2021-08-26

Symptoms: Metal taste

Release 11 — 12 months, dose 2

2022-05-27

Symptoms: Arm still sore as if I just got injection Vision is getting rapidly worse Constant ringing of the ears. Abnormal pap and mammogram tests

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	Dysgeusia	✓	·	✓
SD	Dyspnoea	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Heavy menstrual bleeding	✓	✓	✓
SD	Mammogram abnormal	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Smear cervix abnormal	·	·	✓
SD	Tinnitus	·	·	✓
SD	Vision blurred	✓	✓	✓
SRO	Chest pain	✓	✓	✓
SRO	Dry mouth	✓	✓	✓
SRO	Injection site reaction	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Tinnitus	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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