5W9-24990-86302

5 vaccinations 11 coded responses 33 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 945 / CA
Registered: 2021-02-01

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

2021-01-25
Dose 1 — Moderna
2021-02-01
Registered in v-safe
2021-02-01
Health check-in — day 7, dose 1
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-08
Survey response — day 14, dose 1
MedDRA: Diarrhoea, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling — Feeling: Fair

Free text: Rash near injection grew progressively red, swollen, itchy from Feb 1-4, then began improve. Still mild itch. Last week mild loose stool. I did not report previously: 2 hrs post shot to day 3 sore near shot.Today feel fair - maybe bc st I ate.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — day 21, dose 1
MedDRA: Erythema, Fatigue, Nausea, Peripheral swelling, Pruritus — Feeling: Good

Free text: Monday through Wednesday last week I felt very fatigued and a bit nauseous growing worse through Wednesday. Better Thursday. Redness and swelling in arm decreased and dissipated. Mild intermittent itch remains.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Dose 2 — Moderna
2021-02-22
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-24
Survey response — days 1–6 daily, dose 2
MedDRA: Eructation — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Belching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — days 1–6 daily, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Pain in injection arm wrist to shoulder

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-27
Survey response — days 1–6 daily, dose 2
MedDRA: Eructation — Feeling: Fair · Fatigue or tiredness, Diarrhea

Free text: Belching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-03-08
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-22
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-05
Survey response — day 42, dose 2
MedDRA: Anxiety, Stress — Feeling: Good

Free text: I feel like I have an adrenaline pump inside my belly the last couple weeks. Perhaps just stress & anxiety but dont recall feeling like this previously so thought I would report it as I believe one is not meant to self filter in reporting

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Survey response — 3 months, dose 2
MedDRA: Fatigue, Lacrimation increased, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test negative, Sinus congestion — Feeling: Good · Be unable to work, Be unable to do your normal daily activities

Free text: I had a cold last week. Stuffed sinuses, runny nose, eye watering, sore throat. Fatigue, slight temperature. 2 bad days, 5 days til better. Negative COVID-19 test PCR.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-23
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-07
Dose 3 — Moderna
2021-10-25
Health check-in — day 42, dose 3
Feeling: Good

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

Adult check-in
2022-03-08
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-05-08
Dose 4 — Pfizer-BioNTech
2022-05-14
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-15
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-22
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-29
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-05
Survey response — day 28, dose 4
MedDRA: Chills, Fatigue, Headache, Nasal congestion, Nausea, Oropharyngeal pain, Pyrexia, Rhinorrhoea — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Nasal congestion, runny nose, sore throat, headache, tired, chills, some slight nausea, slight fever.

MedDRA releases: 2024-11 · check-in free text available
2022-06-12
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-06-19
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-07
Survey response — 3 months, dose 4
MedDRA: COVID-19, Chills, Fatigue, Influenza virus test negative, Injection site erythema, Injection site pain, Injection site swelling, Myalgia, Office visit, Pyrexia, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Hospitalization

Free text: Symptoms: 7 weeks post COVID diagnosis per GP routine DTAP & Pneumonia boosters. 7/26/22. I have never had any reaction to these. This time VERY bad reaction. High fever, chills muscle pain, fatigue, pain/red/severe swelling at site. Neg. C19 PCR & Flu tests · Healthcare visit (other): Follow up in person GP visit

MedDRA releases: 2024-11 · check-in free text available
2022-08-07
Report sent to call center — 3 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Hospitalization · 1 call case(s)
2022-08-08
Call 1 — Left Voicemail
2022-08-10
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-10-04
Dose 5 — Moderna
2022-11-06
Survey response — day 28, dose 5
MedDRA: COVID-19, Impaired work ability, Influenza virus test, No reaction on previous exposure to drug, Oropharyngeal pain, Peripheral swelling, Pyrexia, SARS-CoV-2 test — Feeling: Good · Be unable to work or attend school, 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: Symptoms: 2 incidences. 1. 7/27/22I had a very bad reaction to DTAP & Pneumonia given together. High fever. Bad swelling in arm. 4 days unable to work. Never had a reaction before. 2. COVID mild case bad sore throat 10/17/22 · Healthcare visit (other): Drive through COVID & Flu test

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Report sent to call center — day 28, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-11-07
Call 1 — Left Voicemail
2022-11-08
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-11-15
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-04
Survey response — 3 months, dose 5
MedDRA: Cough, Headache, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, Rhinorrhoea — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-04-04
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-25	Moderna
2	2021-02-22	Moderna
3	2021-09-07	Moderna	No
4	2022-05-08	Pfizer-BioNTech	No
5	2022-10-04	Moderna	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 3 — day 14, dose 1

2021-02-08

Symptoms: Rash near injection grew progressively red, swollen, itchy from Feb 1-4, then began improve. Still mild itch. Last week mild loose stool. I did not report previously: 2 hrs post shot to day 3 sore near shot.Today feel fair - maybe bc st I ate.

Release 4 — day 21, dose 1

2021-02-15

Symptoms: Monday through Wednesday last week I felt very fatigued and a bit nauseous growing worse through Wednesday. Better Thursday. Redness and swelling in arm decreased and dissipated. Mild intermittent itch remains.

Release 4 — days 1–6 daily, dose 2

2021-02-24

Systemic reaction (other): Belching

2021-02-25

Systemic reaction (other): Pain in injection arm wrist to shoulder

2021-02-27

Systemic reaction (other): Belching

Release 7 — day 42, dose 2

2021-04-05

Symptoms: I feel like I have an adrenaline pump inside my belly the last couple weeks. Perhaps just stress & anxiety but dont recall feeling like this previously so thought I would report it as I believe one is not meant to self filter in reporting

Release 8 — 3 months, dose 2

2021-05-24

Symptoms: I had a cold last week. Stuffed sinuses, runny nose, eye watering, sore throat. Fatigue, slight temperature. 2 bad days, 5 days til better. Negative COVID-19 test PCR.

Release 11 — day 28, dose 4

2022-06-05

Symptoms: Nasal congestion, runny nose, sore throat, headache, tired, chills, some slight nausea, slight fever.

Release 12 — 3 months, dose 4

2022-08-07

Symptoms: 7 weeks post COVID diagnosis per GP routine DTAP & Pneumonia boosters. 7/26/22. I have never had any reaction to these. This time VERY bad reaction. High fever, chills muscle pain, fatigue, pain/red/severe swelling at site. Neg. C19 PCR & Flu tests cut off by CDC

Healthcare visit (other): Follow up in person GP visit

Release 12 — day 28, dose 5

2022-11-06

Symptoms: 2 incidences. 1. 7/27/22I had a very bad reaction to DTAP & Pneumonia given together. High fever. Bad swelling in arm. 4 days unable to work. Never had a reaction before. 2. COVID mild case bad sore throat 10/17/22

Healthcare visit (other): Drive through COVID & Flu test

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	Influenza virus test	·	·	✓
HCVO	Office visit	·	·	✓
HCVO	SARS-CoV-2 test	·	·	✓
SD	Anxiety	✓	✓	✓
SD	Chills	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Erythema	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Impaired work ability	·	·	✓
SD	Influenza virus test negative	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Lacrimation increased	✓	✓	✓
SD	Myalgia	·	·	✓
SD	Nasal congestion	·	·	✓
SD	Nasopharyngitis	✓	✓	✓
SD	Nausea	✓	✓	✓
SD	No reaction on previous exposure to drug	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Peripheral swelling	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Rhinorrhoea	✓	✓	✓
SD	SARS-CoV-2 test negative	✓	✓	✓
SD	Sinus congestion	✓	✓	✓
SD	Stress	✓	✓	✓
SRO	Eructation	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓

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