5V3-21541-15614

2 vaccinations 9 coded responses 24 check-ins 9 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 016 / MA
Registered: 2021-01-29

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

2021-01-29
Registered in v-safe
2021-01-29
Dose 1 — Moderna
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-01
Survey response — days 1–6 daily, dose 1
MedDRA: Blister, Oral mucosal blistering, Pre-existing disease, Unevaluable event — Feeling: Fair · Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · 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): Please note above are from an ear infection PRIOR to inoculation and some very sore blisters on mouth and face Doctor trying to solve situation · Healthcare visit (other): My symptoms are NOT related to the inoculation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Report sent to call center — days 1–6 daily, dose 1
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)
2021-02-02
Survey response — days 1–6 daily, dose 1
MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · 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: I have just been diagnosed with Shingles and am experiencing many of the symptoms above BUT NOT RELATED to the VACCINATION!! My symptoms FROM the Shingles are very painful .

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Report sent to call center — days 1–6 daily, dose 1
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)
2021-02-03
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Poor · 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: Still suffering from Shingles and experiencing some of the above symptoms NONE related to recent vaccination...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Report sent to call center — days 1–6 daily, dose 1
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)
2021-02-04
Survey response — days 1–6 daily, dose 1
MedDRA: Herpes zoster — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Because of my diagnosis of SHINGLES I experience many of the above symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — day 7, dose 1
MedDRA: Herpes zoster, Pre-existing disease, Unevaluable event — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: I have many of above STILL from a SHINGLES VIRUS

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-02-19
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-26
Dose 2 — Moderna
2021-02-26
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Decreased appetite, Somnolence — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Loss of appetite... slept all day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-03-01
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Headache, Fatigue or tiredness, Diarrhea · Be unable to work

Free text: STILL Dizzy/ Light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Adult check-in
2021-03-02
Report sent to call center — days 1–6 daily, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-03
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Light headed/dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Still light headed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Health check-in — day 7, dose 2
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-09
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-18
Call 1 — Left Voicemail
2021-08-27
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-26
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-29	Moderna
2	2021-02-26	Moderna

Call center

4 call center cases

4 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-01

Systemic reaction (other): Please note above are from an ear infection PRIOR to inoculation and some very sore blisters on mouth and face Doctor trying to solve situation

Healthcare visit (other): My symptoms are NOT related to the inoculation

2021-02-02

Systemic reaction (other): I have just been diagnosed with Shingles and am experiencing many of the symptoms above BUT NOT RELATED to the VACCINATION!! My symptoms FROM the Shingles are very painful .

2021-02-03

Systemic reaction (other): Still suffering from Shingles and experiencing some of the above symptoms NONE related to recent vaccination...

2021-02-04

Systemic reaction (other): Because of my diagnosis of SHINGLES I experience many of the above symptoms

Release 3 — day 7, dose 1

2021-02-05

Systemic reaction (other): I have many of above STILL from a SHINGLES VIRUS

Release 4 — days 1–6 daily, dose 2

2021-02-27

Systemic reaction (other): Loss of appetite... slept all day

2021-03-01

Systemic reaction (other): STILL Dizzy/ Light headed

2021-03-03

Systemic reaction (other): Light headed/dizzy

Release 5 — days 1–6 daily, dose 2

2021-03-04

Systemic reaction (other): Still light headed

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	Unevaluable event	✓	✓	✓
SRO	Blister	✓	✓	✓
SRO	Condition aggravated	✓	✓	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Herpes zoster	✓	✓	✓
SRO	Oral mucosal blistering	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Somnolence	✓	✓	✓
SRO	Unevaluable event	○	✓	○

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