5YH-14975-30854

5 vaccinations 21 coded responses 42 check-ins 21 free-text entries 8 call cases

Sex: —
Age at first dose: 66+
ZIP prefix: 150 / PA
Registered: 2021-01-17

Relationship: Self
Race: N/A
Ethnicity: N/A

Timeline

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

2021-01-15
Dose 1 — Moderna
2021-01-17
Registered in v-safe
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Chills, Fatigue, Malaise, Pyrexia — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Had chills fever malaise painful arm and extreme tiredness over weekend. Better today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-18
Report sent to call center — days 1–6 daily, dose 1
Be unable to work · Be unable to do your normal daily activities

1 call case(s)
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Productive cough — Feeling: Good · Fatigue or tiredness

Free text: Had increase in phlegm starting Saturday. Now subsiding.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Nasopharyngitis, Productive cough — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches

Free text: Develop cold symptoms. Cough. Lot ofphlegm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-22
Survey response — day 7, dose 1
MedDRA: Headache, Productive cough — Feeling: Fair · Site: Pain · Headache, Muscle or body aches

Free text: Still have phlegm but less than yesterday. But more head ache took Tylenol

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Dose 2 — Moderna
2021-02-12
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-16
Survey response — days 1–6 daily, dose 2
MedDRA: Malaise — Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Malaise at times

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Malaise — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Malaise at times

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-05
Survey response — day 21, dose 2
MedDRA: Gingival pain, Pain in jaw, Toothache, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Pain in teeth and gums and jaw Going to see dentist in1 1/2 weeks so answer to nxt question not completed · Healthcare visit (other): Going to see dentist

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-19
Survey response — day 35, dose 2
MedDRA: Implant site pain, Oral surgery, Pain in extremity, Specialist consultation, Toothache — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: To dentist. Going to have 3 implants, had teeth pulled But also pains in both upper arms at times Prob not related to vaccines. But what do I know · Healthcare visit (other): Oral surgery and dentist visits

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Report sent to call center — day 35, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-16
Survey response — 3 months, dose 2
MedDRA: Office visit, Oral surgery, Pain — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Oral surgery. Lots of pain. Not related to covid · Healthcare visit (other): Implant center

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Report sent to call center — 3 months, 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)
2021-06-14
Call 1 — Left Voicemail
2021-08-13
Survey response — 6 months, dose 2
MedDRA: Concussion, Sinusitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: I had a concussion and sinus infection at roughly same time on antibiotics nothing seemingly to do with vaccine

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-24
Dose 3 — Moderna
2021-10-26
Survey response — days 1–6 daily, dose 3
MedDRA: Chills — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Had chills on and off part of yesterday

MedDRA releases: 2024-11 · check-in free text available
2021-10-27
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site pruritus, Injection site swelling, Reaction to previous exposure to any vaccine — Feeling: Good · Site: Pain, Redness, Swelling, Itching

Free text: Swelling and itching at site. Never had c first 2 shots

MedDRA releases: 2024-11 · check-in free text available
2021-10-28
Survey response — days 1–6 daily, dose 3
MedDRA: Pre-existing disease — Feeling: Good · Site: Pain, Redness, Swelling, Itching

Free text: Should say was on 6-7 days of amoxicillin for first 2 days after booster for dental infections. Had tooth removed 3 days prior to this booster also put MG lotion and cereve anti itch lotion on injection site for all these post injection days.

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Pruritus, Self-medication — Feeling: Good · Site: Redness, Swelling, Itching

Free text: Symptoms at site improved Still using cerave itch relief cream

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good · Site: Itching

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2021-10-31
Survey response — day 7, dose 3
MedDRA: Pruritus, Self-medication — Feeling: Good · Site: Itching

Free text: Itching less each day. Cerave anti itch cream really alleviates itch for several hours

MedDRA releases: 2024-11 · check-in free text available
2021-11-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-14
Call 1 — Left Voicemail
2021-11-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-28
Survey response — day 35, dose 3
MedDRA: Self-medication, Vaginal infection — Feeling: Fair

Free text: Vaginal infection. got otc remedy

MedDRA releases: 2024-11 · check-in free text available
2021-12-05
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-23
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-24
Survey response — 6 months, dose 3
MedDRA: Arthralgia, Pain in extremity, Pre-existing disease, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Increased pain left ankle and leg. To see md this week. Had 6 pins placed left ankle 6 years ago due to trimalleolar break. · Healthcare visit (other): Am going to see md this coming Tuesday 4/26

MedDRA releases: 2024-11 · check-in free text available
2022-04-24
Report sent to call center — 6 months, dose 3
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-25
Call 1 — Left Voicemail
2022-06-10
Dose 4 — Moderna
2022-06-28
Survey response — day 14, dose 4
MedDRA: Emergency care, Pain in extremity, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: Have deteriorated condition left ankle. Had ORIF 6 yrs ago. Now c osteopenia changes. Seeing doctor Put on gabapentin. Also staring PT · Healthcare visit (other): ER was to rule out blood clot in left leg. As pain includes calf as well as ankle

MedDRA releases: 2024-11 · check-in free text available
2022-06-28
Report sent to call center — day 14, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-06-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-29
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-01
Survey response — day 21, dose 4
MedDRA: Haematocrit increased, Haemoglobin increased, Red blood cell count increased, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Had blood check. Have elevated RBCs H &H · Healthcare visit (other): To have telehealth visit 8/18/22.Also repeat CBC

MedDRA releases: 2024-11 · check-in free text available
2022-07-01
Report sent to call center — day 21, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-08
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-07-15
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-22
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-09-11
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-27
Dose 5 — Moderna
Co-administered: Pneumonia
2022-12-09
Survey response — 6 months, dose 4
MedDRA: Arthralgia, Office visit, Physiotherapy — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: He'd PT due to painful hips · Healthcare visit (other): Saw MD then had hip X-rays and PT ordered. Also had another moderna valent 10/17/22.

MedDRA releases: 2024-11 · check-in free text available
2022-12-09
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-12-12
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-04-27
Health check-in — 6 months, dose 5
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-10-24	Moderna	No
4	2022-06-10	Moderna	No
5	2022-10-27	Moderna	Pneumonia

Call center

8 call center cases

7 successful · 1 priority 2/3 (triaged and no follow up)

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-18

Systemic reaction (other): Had chills fever malaise painful arm and extreme tiredness over weekend. Better today

2021-01-19

Systemic reaction (other): Had increase in phlegm starting Saturday. Now subsiding.

2021-01-21

Systemic reaction (other): Develop cold symptoms. Cough. Lot ofphlegm

Release 2 — day 7, dose 1

2021-01-22

Systemic reaction (other): Still have phlegm but less than yesterday. But more head ache took Tylenol

Release 4 — days 1–6 daily, dose 2

2021-02-16

Systemic reaction (other): Malaise at times

2021-02-17

Systemic reaction (other): Malaise at times

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Pain in teeth and gums and jaw Going to see dentist in1 1/2 weeks so answer to nxt question not completed

Healthcare visit (other): Going to see dentist

Release 6 — day 35, dose 2

2021-03-19

Symptoms: To dentist. Going to have 3 implants, had teeth pulled But also pains in both upper arms at times Prob not related to vaccines. But what do I know

Healthcare visit (other): Oral surgery and dentist visits

Release 8 — 3 months, dose 2

2021-05-16

Symptoms: Oral surgery. Lots of pain. Not related to covid

Healthcare visit (other): Implant center

Release 9 — 6 months, dose 2

2021-08-13

Symptoms: I had a concussion and sinus infection at roughly same time on antibiotics nothing seemingly to do with vaccine

Release 10 — days 1–6 daily, dose 3

2021-10-26

Systemic reaction (other): Had chills on and off part of yesterday

2021-10-27

Systemic reaction (other): Swelling and itching at site. Never had c first 2 shots

2021-10-28

Systemic reaction (other): Should say was on 6-7 days of amoxicillin for first 2 days after booster for dental infections. Had tooth removed 3 days prior to this booster also put MG lotion and cereve anti itch lotion on injection site for all these post injection days.

2021-10-29

Systemic reaction (other): Symptoms at site improved Still using cerave itch relief cream

2021-10-30

Systemic reaction (other): None

Release 10 — day 7, dose 3

2021-10-31

Systemic reaction (other): Itching less each day. Cerave anti itch cream really alleviates itch for several hours

Release 10 — day 35, dose 3

2021-11-28

Symptoms: Vaginal infection. got otc remedy

Release 11 — 6 months, dose 3

2022-04-24

Symptoms: Increased pain left ankle and leg. To see md this week. Had 6 pins placed left ankle 6 years ago due to trimalleolar break.

Healthcare visit (other): Am going to see md this coming Tuesday 4/26

Release 12 — day 14, dose 4

2022-06-28

Symptoms: Have deteriorated condition left ankle. Had ORIF 6 yrs ago. Now c osteopenia changes. Seeing doctor Put on gabapentin. Also staring PT

Healthcare visit (other): ER was to rule out blood clot in left leg. As pain includes calf as well as ankle

Release 12 — day 21, dose 4

2022-07-01

Symptoms: Had blood check. Have elevated RBCs H &H

Healthcare visit (other): To have telehealth visit 8/18/22.Also repeat CBC

Release 12 — 6 months, dose 4

2022-12-09

Symptoms: He'd PT due to painful hips

Healthcare visit (other): Saw MD then had hip X-rays and PT ordered. Also had another moderna valent 10/17/22.

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	Emergency care	·	·	✓
HCVO	Office visit	✓	✓	✓
HCVO	Oral surgery	✓	✓	✓
HCVO	Pain in extremity	·	·	✓
HCVO	Specialist consultation	✓	✓	✓
HCVO	Unevaluable event	✓	✓	✓
SD	Arthralgia	·	·	✓
SD	Concussion	✓	·	✓
SD	Gingival pain	✓	✓	✓
SD	Haematocrit increased	·	·	✓
SD	Haemoglobin increased	·	·	✓
SD	Implant site pain	✓	✓	✓
SD	Oral surgery	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	✓	✓	✓
SD	Pain in jaw	✓	✓	✓
SD	Physiotherapy	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Red blood cell count increased	·	·	✓
SD	Self-medication	·	·	✓
SD	Sinusitis	✓	·	✓
SD	Toothache	✓	✓	✓
SD	Vaginal infection	·	·	✓
SRO	Chills	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Fatigue	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site pruritus	·	·	✓
SRO	Injection site swelling	·	·	✓
SRO	Malaise	✓	✓	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	No adverse event	·	·	✓
SRO	Pre-existing disease	·	·	✓
SRO	Productive cough	✓	✓	✓
SRO	Pruritus	·	·	✓
SRO	Pyrexia	✓	✓	✓
SRO	Reaction to previous exposure to any vaccine	·	·	✓
SRO	Self-medication	·	·	✓

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