5ZV-59904-30001

3 vaccinations 7 coded responses 20 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 984 / WA
Registered: 2021-02-24

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

2021-02-11
Dose 1 — Moderna
2021-02-24
Registered in v-safe
2021-02-25
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-11
Dose 2 — Moderna
2021-03-11
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Malaise — Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: definite malaise

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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
2021-03-15
Survey response — days 1–6 daily, dose 2
MedDRA: Fatigue — Feeling: Fair

Free text: Tired, even though I got a good night sleep

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-17
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Good

Free text: happy as a clam in the beach sand.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-25
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-01
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-10
Survey response — 3 months, dose 2
MedDRA: Arthralgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Increase and acutely developing of hip pain.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-09
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Muscular weakness, Myalgia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Last vax was Mar 11. In April to May I developed a sore hip that cropped fairly suddenly without known injury. Also have had more muscle weakness & soreness with ordinary exercise than usual and without known injury.

MedDRA releases: 2024-11 · check-in free text available
2021-11-17
Dose 3 — Moderna
2022-03-11
Survey response — 12 months, dose 2
MedDRA: Atrial fibrillation, Office visit, Supraventricular tachycardia — 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 · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit

Free text: Symptoms: I have developed a-fib and paroxsymal wide complex tachy-cardia as of Fall of 2021. Currently under treatment assessment. · Healthcare visit (other): multiple tests; referrals to 2 different cardiologist specialists.

MedDRA releases: 2024-11 · check-in free text available
2022-03-11
Report sent to call center — 12 months, dose 2
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 · Emergency room or emergency department visit · 1 call case(s)
2022-03-24
Call 1 — Left Voicemail
2022-03-29
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-18
Survey response — 6 months, dose 3
MedDRA: Atrial fibrillation, Atrial flutter, Supraventricular extrasystoles, Unevaluable event, Ventricular extrasystoles — 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, Hospitalization

Free text: Symptoms: I was diagnosed & treated for A-fib with RVR, A-Flutter, PVC, & PAC · Healthcare visit (other): cardiac catherization proceduree

MedDRA releases: 2024-11 · check-in free text available
2022-05-18
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

Outpatient clinic or urgent care clinic visit · Hospitalization · 1 call case(s)
2022-05-19
Call 1 — Requested Callback
2022-05-20
Call 2 — Left Voicemail
2022-05-20
Callback requested for
03:05PM ET
2022-05-24
Call successful
Not applicable - Accidental Reporting
2022-11-17
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-11	Moderna
2	2021-03-11	Moderna
3	2021-11-17	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-12

Systemic reaction (other): definite malaise

2021-03-15

Systemic reaction (other): Tired, even though I got a good night sleep

2021-03-17

Systemic reaction (other): happy as a clam in the beach sand.

Release 9 — 3 months, dose 2

2021-06-10

Symptoms: Increase and acutely developing of hip pain.

Release 9 — 6 months, dose 2

2021-09-09

Symptoms: Last vax was Mar 11. In April to May I developed a sore hip that cropped fairly suddenly without known injury. Also have had more muscle weakness & soreness with ordinary exercise than usual and without known injury.

Release 11 — 12 months, dose 2

2022-03-11

Symptoms: I have developed a-fib and paroxsymal wide complex tachy-cardia as of Fall of 2021. Currently under treatment assessment.

Healthcare visit (other): multiple tests; referrals to 2 different cardiologist specialists.

Release 11 — 6 months, dose 3

2022-05-18

Symptoms: I was diagnosed & treated for A-fib with RVR, A-Flutter, PVC, & PAC

Healthcare visit (other): cardiac catherization proceduree

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	Unevaluable event	·	·	✓
SD	Arthralgia	✓	✓	✓
SD	Atrial fibrillation	·	·	✓
SD	Atrial flutter	·	·	✓
SD	Muscular weakness	·	·	✓
SD	Myalgia	·	·	✓
SD	Supraventricular extrasystoles	·	·	✓
SD	Supraventricular tachycardia	·	·	✓
SD	Ventricular extrasystoles	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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