5UX-35122-79559

2 vaccinations 10 coded responses 24 check-ins 10 free-text entries 7 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 453 / OH
Registered: 2020-12-29

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

2020-12-28
Dose 1 — Moderna
2020-12-29
Registered in v-safe
2020-12-29
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2020-12-30
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2020-12-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

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

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-01-04
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-11
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site warmth, Medical counselling, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: On evening of 1/5/21, developed arm pain in vaccinated arm. The next am in shower noticed reddened hot area on R upper arm at site of injection. Area continue to spread throughout the day and evening. · Healthcare visit (other): Contacted my supervisor at work on 1/6, spoke with employee health on 1/7. The RN in employee health reported it as a level 3 adverse event to CDC.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-19
Survey response — day 21, dose 1
MedDRA: Erythema, Pain in extremity — Feeling: Good

Free text: R arm (arm that was injected) still periodically hurts & becomes reddened

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-25
Dose 2 — Moderna
2021-01-26
Survey response — days 1–6 daily, dose 2
MedDRA: Erythema, Pain in extremity — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: I no longer have any redness or soreness on my other arm where I received my first vaccine & had a level 3 reaction reported by my employer to the CDC.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Survey response — days 1–6 daily, dose 2
MedDRA: Anaphylactic reaction, Dizziness, Dyspnoea, Dysstasia, Emergency care, Fall, Feeling hot, Unevaluable event, Vertigo — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization

Free text: Systemic reaction (other): I experienced vertigo this am at work, to the point of feeling like I was going to pass out. I felt hot, short of breath. I could not stand & fell to the floor. I work in a health care facility & emergency services were called. I was transported to the ER for eval & tx. Admitted for allergic reaction to vaccine. · Healthcare visit (other): See above

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-28
Survey response — days 1–6 daily, dose 2
MedDRA: Hospitalisation, Hypersensitivity — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Hospitalization

Free text: Remained hospitalized due to allergic reaction to vaccine until mid afternoon today. Remain on steroids, Benadryl, Pepcid. During hospitalization received IV fluids also.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-29
Survey response — days 1–6 daily, dose 2
MedDRA: Discharge, Hospitalisation, Hypersensitivity, Syncope — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Free text: Just discharged from hospital yesterday 1/28/2021 late afternoon for allergic reaction to vaccine & syncope.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Survey response — days 1–6 daily, dose 2
MedDRA: Diarrhoea, Office visit, Urinary tract infection — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Systemic reaction (other): Developed a UTI 1/29 afternoon related to all the diarrhea Ive had since the vaccine. Required visit to urgent care last pm at 8 pm. · Healthcare visit (other): Tried calling my PCP office after hours but was referred to urgent care.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-30
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-31
Survey response — days 1–6 daily, dose 2
MedDRA: Medical counselling, Urinary tract infection — Feeling: Fair · Site: Redness, Itching · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): UTI continues. Urgent care called. Changed antibiotic due to results of urine culture & sensitivity. · Healthcare visit (other): Phone call from urgent care provider

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-01
Survey response — day 7, dose 2
MedDRA: Drug intolerance, Medical counselling, Urinary tract infection — Feeling: Fair · Site: Redness, Itching · Headache, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Systemic reaction (other): Current UTI, antibiotic intolerance · Healthcare visit (other): PCP changed antibiotic

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Report sent to call center — day 7, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-02-22
Call 1 — Left Voicemail
2021-03-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-26
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-07-26
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Back pain, Myelopathy, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Developed lower back & hip pain related to spinal degenerative issues · Healthcare visit (other): PCP vist, X-rays, referral to PT

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-26
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-07-27
Call 1 — Left Voicemail
2022-01-27
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-28	Moderna
2	2021-01-25	Moderna

Call center

7 call center cases

7 unsuccessful

See the call center timeline

Free text

Release 1 — day 14, dose 1

2021-01-11

Symptoms: On evening of 1/5/21, developed arm pain in vaccinated arm. The next am in shower noticed reddened hot area on R upper arm at site of injection. Area continue to spread throughout the day and evening.

Healthcare visit (other): Contacted my supervisor at work on 1/6, spoke with employee health on 1/7. The RN in employee health reported it as a level 3 adverse event to CDC.

Release 2 — day 21, dose 1

2021-01-19

Symptoms: R arm (arm that was injected) still periodically hurts & becomes reddened

Release 2 — days 1–6 daily, dose 2

2021-01-26

Systemic reaction (other): I no longer have any redness or soreness on my other arm where I received my first vaccine & had a level 3 reaction reported by my employer to the CDC.

2021-01-27

Systemic reaction (other): I experienced vertigo this am at work, to the point of feeling like I was going to pass out. I felt hot, short of breath. I could not stand & fell to the floor. I work in a health care facility & emergency services were called. I was transported to the ER for eval & tx. Admitted for allergic reaction to vaccine.

Healthcare visit (other): See above

2021-01-28

Systemic reaction (other): Remained hospitalized due to allergic reaction to vaccine until mid afternoon today. Remain on steroids, Benadryl, Pepcid. During hospitalization received IV fluids also.

Release 3 — days 1–6 daily, dose 2

2021-01-29

Systemic reaction (other): Just discharged from hospital yesterday 1/28/2021 late afternoon for allergic reaction to vaccine & syncope.

2021-01-30

Systemic reaction (other): Developed a UTI 1/29 afternoon related to all the diarrhea Ive had since the vaccine. Required visit to urgent care last pm at 8 pm.

Healthcare visit (other): Tried calling my PCP office after hours but was referred to urgent care.

2021-01-31

Systemic reaction (other): UTI continues. Urgent care called. Changed antibiotic due to results of urine culture & sensitivity.

Healthcare visit (other): Phone call from urgent care provider

Release 3 — day 7, dose 2

2021-02-01

Systemic reaction (other): Current UTI, antibiotic intolerance

Healthcare visit (other): PCP changed antibiotic

Release 9 — 6 months, dose 2

2021-07-26

Symptoms: Developed lower back & hip pain related to spinal degenerative issues

Healthcare visit (other): PCP vist, X-rays, referral to PT

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	Medical counselling	✓	✓	✓
HCVO	Medical observation	○	○	○
HCVO	Office visit	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	✓	·	✓
SD	Back pain	✓	·	✓
SD	Erythema	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site warmth	✓	✓	✓
SD	Myelopathy	✓	·	✓
SD	Pain in extremity	✓	✓	✓
SRO	Anaphylactic reaction	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Discharge	✓	✓	○
SRO	Dizziness	✓	✓	✓
SRO	Drug intolerance	✓	✓	✓
SRO	Dyspnoea	✓	✓	✓
SRO	Dysstasia	✓	✓	✓
SRO	Emergency care	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Fall	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Office visit	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Syncope	✓	✓	✓
SRO	Urinary tract infection	✓	✓	✓
SRO	Vertigo	✓	✓	✓

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