64S-17629-94312

3 vaccinations 12 coded responses 26 check-ins 12 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 967 / HI
Registered: 2021-02-18

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

2021-02-18
Registered in v-safe
2021-02-18
Dose 1 — Moderna
2021-02-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-22
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-27
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-04
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-16
Dose 2 — Moderna
2021-03-17
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Fair · Site: Itching · Fever · Fatigue or tiredness, Diarrhea

Free text: Itching in upper right arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Chills, Fatigue or tiredness

Adult check-in
2021-03-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Fatigue or tiredness

Adult check-in
2021-03-21
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: A little bit dizzy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-22
Survey response — days 1–6 daily, dose 2
MedDRA: Malaise — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Feel a little bit lousy but Im sure Ill get over it. I hope a booster comes available from Moderno soon because I want it

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Survey response — day 7, dose 2
MedDRA: Asthenia, Feeling abnormal — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Feeling lousy. Not any energy at all

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-04-06
Survey response — day 21, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities

Free text: Excessive

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — day 28, dose 2
MedDRA: Diarrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Continuing diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-04-27
Survey response — day 42, dose 2
MedDRA: Arthropod bite, Malaise, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities

Free text: I got bit by a spider three times on my left arm which made me feel really crappy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-18
Survey response — 3 months, dose 2
MedDRA: Diarrhoea — Feeling: Fair · Be unable to do your normal daily activities

Free text: Continue diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-18
Dose 3 — Moderna
2021-09-14
Survey response — 6 months, dose 2
MedDRA: Ear pain, Headache, Malaise, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: I had a flu shot the week after and I was feeling sick with low-grade fever headache and earache. I dont know that this was a result of my booster shot or not. I was sick for about 10 days but I am feeling a little bit better now. Thank you

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Survey response — 3 months, dose 3
MedDRA: Arthropod bite, Bronchitis, Malaise, Office visit — 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

Free text: Symptoms: I was bit by a brown recluse spider I'm not feeling well. Also have bronchitis in my left lung so I'm not feeling great great · Healthcare visit (other): Saw my PCP

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Report sent to call center — 3 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 · 1 call case(s)
2021-11-29
Call 1 — Left Voicemail
2021-11-29
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-02-16
Survey response — 6 months, dose 3
MedDRA: Arthropod bite, Malaise, Pain, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: I was bitten by a brown recluse spider that made me very very sick: fever pain

MedDRA releases: 2024-11 · check-in free text available
2022-08-18
Survey response — 12 months, dose 3
MedDRA: Accident at home, Craniocerebral injury — Feeling: Fair

Free text: I have a TBI from an accident in my house

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-18	Moderna
2	2021-03-16	Moderna
3	2021-08-18	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-17

Systemic reaction (other): Itching in upper right arm

Release 6 — days 1–6 daily, dose 2

2021-03-21

Systemic reaction (other): A little bit dizzy

2021-03-22

Systemic reaction (other): Feel a little bit lousy but Im sure Ill get over it. I hope a booster comes available from Moderno soon because I want it

Release 6 — day 7, dose 2

2021-03-23

Systemic reaction (other): Feeling lousy. Not any energy at all

Release 7 — day 21, dose 2

2021-04-06

Symptoms: Excessive

Release 7 — day 28, dose 2

2021-04-14

Symptoms: Continuing diarrhea

Release 8 — day 42, dose 2

2021-04-27

Symptoms: I got bit by a spider three times on my left arm which made me feel really crappy

Release 9 — 3 months, dose 2

2021-06-18

Symptoms: Continue diarrhea

Release 9 — 6 months, dose 2

2021-09-14

Symptoms: I had a flu shot the week after and I was feeling sick with low-grade fever headache and earache. I dont know that this was a result of my booster shot or not. I was sick for about 10 days but I am feeling a little bit better now. Thank you

Release 10 — 3 months, dose 3

2021-11-21

Symptoms: I was bit by a brown recluse spider I'm not feeling well. Also have bronchitis in my left lung so I'm not feeling great great

Healthcare visit (other): Saw my PCP

Release 11 — 6 months, dose 3

2022-02-16

Symptoms: I was bitten by a brown recluse spider that made me very very sick: fever pain

Release 12 — 12 months, dose 3

2022-08-18

Symptoms: I have a TBI from an accident in my house

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	·	·	✓
SD	Accident at home	·	·	✓
SD	Arthropod bite	✓	·	✓
SD	Bronchitis	·	·	✓
SD	Craniocerebral injury	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Ear pain	·	·	✓
SD	Headache	·	·	✓
SD	Malaise	✓	·	✓
SD	Pain	·	·	✓
SD	Pyrexia	·	·	✓
SD	Unevaluable event	✓	✓	✓
SRO	Asthenia	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Pruritus	✓	✓	✓

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