5ZR-12955-55176

3 vaccinations 9 coded responses 22 check-ins 8 free-text entries 0 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 921 / CA
Registered: 2021-04-27

Relationship: Self
Race: White
Ethnicity: 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

2021-04-27
Registered in v-safe
2021-04-27
Dose 1 — Moderna
2021-04-27
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-28
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Free text: Didnt have breakfast or lunch

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-04-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-26
Dose 2 — Moderna
2021-05-27
Survey response — days 1–6 daily, dose 2
MedDRA: Migraine — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work, Be unable to do your normal daily activities

Free text: Severe Migraine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-28
Survey response — days 1–6 daily, dose 2
MedDRA: Headache, Injection site bruising, Neck pain — Feeling: Good · Muscle or body aches

Free text: Injection site Bruising; pain at base of head/neck.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-29
Survey response — days 1–6 daily, dose 2
MedDRA: Headache, Injection site bruising, Injection site pain, Neck pain, Urinary tract infection — Feeling: Fair · Site: Pain · Muscle or body aches

Free text: Intermittent Throbbing mild pain/soreness at the left lower base of my head/neck, almost like going up in a line to the left middle/side of my head. Bruising at injection site and mild pain when touched. Diagnosed UTI.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-30
Survey response — days 1–6 daily, dose 2
MedDRA: Eye swelling, Hypersensitivity, Injection site bruising — Feeling: Fair

Free text: Injection site bruising. Unrelated mysterious allergic reaction to something. Eyes swollen shut.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-31
Survey response — days 1–6 daily, dose 2
MedDRA: Dry eye, Eye irritation, Eyelid rash — Feeling: Good · Rash, not including the immediate area around the injection site

Free text: Some kind of rash around both eyes but worse on left eye. Eyes are dry and irritated. Not sure if allergic reaction to something or if its a normal seasonal allergy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-04
Survey response — day 7, dose 2
MedDRA: Injection site bruising, Injection site discolouration — Feeling: Good

Free text: Bruising around injection site is fading to a yellowish color.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-26
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-30
Survey response — day 35, dose 2
MedDRA: Hypomenorrhoea, Menstrual disorder — Feeling: Good

Free text: Very light period. Different from normal. Otherwise, Im fine.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-07
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-05
Dose 3 — Moderna
2022-07-06
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-01-05
Survey response — 12 months, dose 3
MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-27	Moderna
2	2021-05-26	Moderna
3	2022-01-05	Moderna	No

Free text

Release 8 — days 1–6 daily, dose 1

2021-04-28

Systemic reaction (other): Didnt have breakfast or lunch

Release 8 — days 1–6 daily, dose 2

2021-05-27

Systemic reaction (other): Severe Migraine

2021-05-28

Systemic reaction (other): Injection site Bruising; pain at base of head/neck.

2021-05-29

Systemic reaction (other): Intermittent Throbbing mild pain/soreness at the left lower base of my head/neck, almost like going up in a line to the left middle/side of my head. Bruising at injection site and mild pain when touched. Diagnosed UTI.

2021-05-30

Systemic reaction (other): Injection site bruising. Unrelated mysterious allergic reaction to something. Eyes swollen shut.

2021-05-31

Systemic reaction (other): Some kind of rash around both eyes but worse on left eye. Eyes are dry and irritated. Not sure if allergic reaction to something or if its a normal seasonal allergy.

Release 8 — day 7, dose 2

2021-06-04

Systemic reaction (other): Bruising around injection site is fading to a yellowish color.

Release 9 — day 35, dose 2

2021-06-30

Symptoms: Very light period. Different from normal. Otherwise, Im fine.

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	Hypomenorrhoea	✓	✓	✓
SD	Menstrual disorder	✓	✓	✓
SD	SARS-CoV-2 test positive	·	·	✓
SRO	Dry eye	✓	✓	✓
SRO	Eye irritation	✓	✓	✓
SRO	Eye swelling	✓	✓	✓
SRO	Eyelid rash	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site discolouration	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Migraine	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓
SRO	Urinary tract infection	✓	✓	✓

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