5ZQ-13037-44503

3 vaccinations 11 coded responses 17 check-ins 11 free-text entries 4 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 307 / GA
Registered: 2021-08-27

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

2021-08-21
Dose 1 — Moderna
2021-08-27
Registered in v-safe
2021-08-27
Survey response — days 1–6 daily, dose 1
MedDRA: No adverse event, Office visit — Feeling: Fair · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): No · Healthcare visit (other): Pulmonary doctors appt.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-27
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-28
Survey response — day 7, dose 1
MedDRA: Chest pain, Dyspnoea, Painful respiration — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Chest pain when I was trying to take a breath and it was an extremely sharp pain when I tried to inhale.. . I couldn't breath in for the sharp pain that seemed to catch when I took a breath

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-02
Call 1 — Left Voicemail
2021-09-04
Survey response — day 14, dose 1
MedDRA: Balance disorder, Chest pain, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: Increased congestion. Chest pain. Balance off .

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-11
Survey response — day 21, dose 1
MedDRA: Fatigue, Malaise, Metamorphopsia, Rhinorrhoea — Feeling: Poor · Be unable to do your normal daily activities

Free text: Had 2 spells the last few days where vision has become distorted to where you can't tell what anything is. Constant runny nose. Extreme fatigue and a general unwell feeling.

MedDRA releases: 2024-11 · check-in free text available
2021-09-19
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-09-20
Dose 2 — Moderna
2021-09-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-26
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-09-27
Survey response — day 7, dose 2
MedDRA: Respiratory tract congestion — Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Really congested today.

MedDRA releases: 2024-11 · check-in free text available
2021-10-04
Survey response — day 14, dose 2
MedDRA: Back pain, Chest pain, Headache, Nausea, Self-medication — Feeling: Poor · Be unable to do your normal daily activities

Free text: Chestpain i. Chest and a back pain between back shoulder blades. Took nitro. Chest pain was relieved but back was not and had severe headache and nausea that would not let up. So stayed in bed majority of day.

MedDRA releases: 2024-11 · check-in free text available
2021-10-11
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-10-20
Survey response — day 28, dose 2
MedDRA: Arthralgia, Chest pain, Dyspnoea, Hypertension, Nasopharyngitis, Office visit, Pre-existing disease, Sitting disability — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Chest pain, BP higher, breathing worsened, cold like symptoms. Severe hip pain. Got steroid and numbing injection in hip and has had no relief and is getting worse. I cannot sit for long periods at a time due to severe pain. · Healthcare visit (other): Neurologist that I see for pain management and deteriorating spine disease.

MedDRA releases: 2024-11 · check-in free text available
2021-10-20
Report sent to call center — day 28, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-10-22
Call 1 — Left Voicemail
2021-10-25
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-11-01
Survey response — day 42, dose 2
MedDRA: Dyspnoea, Headache, Pain in extremity, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities

Free text: Severe chest congestion and headache. Shortness of breath. Overall pain in legs.

MedDRA releases: 2024-11 · check-in free text available
2021-12-23
Survey response — 3 months, dose 2
MedDRA: Back pain, Hypoaesthesia, Office visit, Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Severe back and leg pain. Numbing in leg. · Healthcare visit (other): Dr office visit.

MedDRA releases: 2024-11 · check-in free text available
2021-12-23
Report sent to call center — 3 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-23
Call 1 — Left Voicemail
2022-05-19
Dose 3 — Moderna
Co-administered: Shingles
2022-06-29
Survey response — day 35, dose 3
MedDRA: Chest pain, Condition aggravated, Depression, Fatigue, Paranasal sinus hypersecretion, Pre-existing disease, Productive cough, Sinus congestion, Somnolence — Feeling: Fair · 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: COPD has worsened! More coughing and more muocous comes up. Severe fatigue and wanting to sleep all the time! Depression is more severe but receiving treatment for this. A lot of sinus drainage and congestion. More chest pain at times! Being treated

MedDRA releases: 2024-11 · check-in free text available
2022-06-29
Report sent to call center — day 35, dose 3
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)
2022-06-30
Survey response — day 42, dose 3
MedDRA: Increased viscosity of upper respiratory secretion, Pre-existing disease, Productive cough, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: More muocous in chest I'm coughing up. A lot thicker, but I think it may be possibly bronchitis or my emphysema is acting up. Don't really think it's from the COVID vaccine. Just some changes I have noticed this past week.

MedDRA releases: 2024-11 · check-in free text available
2022-06-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-06-30
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-19
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-08-21	Moderna	No
2	2021-09-20	Moderna	No
3	2022-05-19	Moderna	Shingles

Call center

4 call center cases

4 successful

See the call center timeline

Free text

Release 9 — days 1–6 daily, dose 1

2021-08-27

Systemic reaction (other): No

Healthcare visit (other): Pulmonary doctors appt.

Release 9 — day 7, dose 1

2021-08-28

Systemic reaction (other): Chest pain when I was trying to take a breath and it was an extremely sharp pain when I tried to inhale.. . I couldn't breath in for the sharp pain that seemed to catch when I took a breath

Release 9 — day 14, dose 1

2021-09-04

Symptoms: Increased congestion. Chest pain. Balance off .

Release 9 — day 21, dose 1

2021-09-11

Symptoms: Had 2 spells the last few days where vision has become distorted to where you can't tell what anything is. Constant runny nose. Extreme fatigue and a general unwell feeling.

Release 9 — day 7, dose 2

2021-09-27

Systemic reaction (other): Really congested today.

Release 10 — day 14, dose 2

2021-10-04

Symptoms: Chestpain i. Chest and a back pain between back shoulder blades. Took nitro. Chest pain was relieved but back was not and had severe headache and nausea that would not let up. So stayed in bed majority of day.

Release 10 — day 28, dose 2

2021-10-20

Symptoms: Chest pain, BP higher, breathing worsened, cold like symptoms. Severe hip pain. Got steroid and numbing injection in hip and has had no relief and is getting worse. I cannot sit for long periods at a time due to severe pain.

Healthcare visit (other): Neurologist that I see for pain management and deteriorating spine disease.

Release 10 — day 42, dose 2

2021-11-01

Symptoms: Severe chest congestion and headache. Shortness of breath. Overall pain in legs.

Release 10 — 3 months, dose 2

2021-12-23

Symptoms: Severe back and leg pain. Numbing in leg.

Healthcare visit (other): Dr office visit.

Release 12 — day 35, dose 3

2022-06-29

Symptoms: COPD has worsened! More coughing and more muocous comes up. Severe fatigue and wanting to sleep all the time! Depression is more severe but receiving treatment for this. A lot of sinus drainage and congestion. More chest pain at times! Being treated cut off by CDC

Release 12 — day 42, dose 3

2022-06-30

Symptoms: More muocous in chest I'm coughing up. A lot thicker, but I think it may be possibly bronchitis or my emphysema is acting up. Don't really think it's from the COVID vaccine. Just some changes I have noticed this past week.

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	Office visit	✓	·	✓
HCVO	Pre-existing disease	·	·	✓
SD	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Balance disorder	✓	·	✓
SD	Chest pain	✓	·	✓
SD	Condition aggravated	·	·	✓
SD	Depression	·	·	✓
SD	Dyspnoea	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Hypertension	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Increased viscosity of upper respiratory secretion	·	·	✓
SD	Malaise	·	·	✓
SD	Metamorphopsia	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Paranasal sinus hypersecretion	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Productive cough	·	·	✓
SD	Respiratory tract congestion	✓	·	✓
SD	Rhinorrhoea	·	·	✓
SD	Self-medication	·	·	✓
SD	Sinus congestion	·	·	✓
SD	Sitting disability	·	·	✓
SD	Somnolence	·	·	✓
SRO	Chest pain	✓	·	✓
SRO	Dyspnoea	✓	·	✓
SRO	No adverse event	✓	·	✓
SRO	Painful respiration	✓	·	✓
SRO	Respiratory tract congestion	·	·	✓

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