5XE-22455-92891

2 vaccinations 11 coded responses 22 check-ins 11 free-text entries 0 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 969
Registered: 2021-01-30

Relationship: Self
Race: Native Hawaiian or other Pacific Islander
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

2021-01-26
Dose 1 — Moderna
2021-01-30
Registered in v-safe
2021-01-30
Survey response — days 1–6 daily, dose 1
MedDRA: Hypoaesthesia, Immediate post-injection reaction, Throat tightness — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Free text: 45 minutes after vaccination I had a headache took Tylenol right away. Then 30 mins after having the headache my jaw started to numb and throat felt a bit tight. Took Benadryl right away

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-31
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus, Rash — Feeling: Fair · Rash, not including the immediate area around the injection site

Free text: Rash/itching around chest and neck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-01
Survey response — days 1–6 daily, dose 1
MedDRA: Rash — Feeling: Fair · Diarrhea, Rash, not including the immediate area around the injection site

Free text: Rash is getting worst

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-02
Health check-in — day 7, dose 1
Feeling: Good · Rash, not including the immediate area around the injection site

Adult check-in
2021-02-10
Survey response — day 14, dose 1
MedDRA: Heavy menstrual bleeding, Menstruation irregular — Feeling: Good

Free text: Had my period twice this month and the 2nd time around I still have it and im on my 20th day

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — day 21, dose 1
MedDRA: Chills, Fatigue, Headache, Pain, Respiratory tract congestion, Rhinorrhoea — Feeling: Poor · Be unable to do your normal daily activities

Free text: Body aches, runny nose, chills, headache Head congestion, feel exhausted

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Survey response — day 28, dose 1
MedDRA: Rash — Feeling: Good

Free text: Rash

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-04
Health check-in — day 35, dose 1
Feeling: Fair

Adult check-in
2021-03-08
Dose 2 — Moderna
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache, Joint pains

Adult check-in
2021-03-12
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Diarrhea

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-03-29
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-05
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-12
Survey response — day 35, dose 2
MedDRA: Headache, Pain — Feeling: Fair

Free text: Headache/ body aches

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Survey response — day 42, dose 2
MedDRA: Rash — Feeling: Good

Free text: Rash is back

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-07
Survey response — 3 months, dose 2
MedDRA: Anxiety, Nervousness — Feeling: Good · Be unable to do your normal daily activities

Free text: Anxiety Nervousness anxious

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-06
Survey response — 6 months, dose 2
MedDRA: Memory impairment — Feeling: Good

Free text: Notice Ive been forgetting things a lot lately

MedDRA releases: 2021-09,2024-11 · check-in free text available
2022-03-09
Survey response — 12 months, dose 2
MedDRA: Memory impairment — Feeling: Fair

Free text: Forgetting things often

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-03-08	Moderna

Free text

Release 3 — days 1–6 daily, dose 1

2021-01-30

Systemic reaction (other): 45 minutes after vaccination I had a headache took Tylenol right away. Then 30 mins after having the headache my jaw started to numb and throat felt a bit tight. Took Benadryl right away

2021-01-31

Systemic reaction (other): Rash/itching around chest and neck

2021-02-01

Systemic reaction (other): Rash is getting worst

Release 4 — day 14, dose 1

2021-02-10

Symptoms: Had my period twice this month and the 2nd time around I still have it and im on my 20th day

Release 4 — day 21, dose 1

2021-02-16

Symptoms: Body aches, runny nose, chills, headache Head congestion, feel exhausted

Release 4 — day 28, dose 1

2021-02-25

Symptoms: Rash

Release 7 — day 35, dose 2

2021-04-12

Symptoms: Headache/ body aches

Release 7 — day 42, dose 2

2021-04-19

Symptoms: Rash is back

Release 8 — 3 months, dose 2

2021-06-07

Symptoms: Anxiety Nervousness anxious

Release 9 — 6 months, dose 2

2021-09-06

Symptoms: Notice Ive been forgetting things a lot lately

Release 11 — 12 months, dose 2

2022-03-09

Symptoms: Forgetting things often

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	Anxiety	✓	✓	✓
SD	Chills	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Heavy menstrual bleeding	✓	✓	✓
SD	Memory impairment	✓	·	✓
SD	Menstruation irregular	·	·	✓
SD	Nervousness	·	·	✓
SD	Pain	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Respiratory tract congestion	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Hypoaesthesia	✓	✓	✓
SRO	Immediate post-injection reaction	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓
SRO	Throat tightness	✓	✓	✓

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