68H-19016-95396

4 vaccinations 8 coded responses 39 check-ins 8 free-text entries 3 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 993 / WA
Registered: 2021-01-22

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

2021-01-22
Registered in v-safe
2021-01-22
Dose 1 — Moderna
2021-01-22
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-25
Survey response — days 1–6 daily, dose 1
MedDRA: Ocular discomfort — Feeling: Fair · Fever · Fatigue or tiredness

Free text: My eyes feel weird.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-26
Survey response — days 1–6 daily, dose 1
MedDRA: Body temperature increased — Feeling: Good · Site: Redness · Chills

Free text: My temperature was 98.8.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fever · Headache, Fatigue or tiredness

Adult check-in
2021-01-28
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site bruising — Feeling: Fair · Site: Redness · Fatigue or tiredness, Rash, not including the immediate area around the injection site

Free text: I have a small bruise by the injection sight. I also have a rash on my face but I had it before the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-29
Health check-in — day 7, dose 1
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-05
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-12
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-19
Health check-in — day 0, dose 2
Feeling: Good · Chills

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-02-21
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Chills, Muscle or body aches

Adult check-in
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Respiratory tract congestion, Seasonal allergy — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Abdominal pain

Free text: Feeling congested but it is allergy season perhaps.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-02-26
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-20
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-31
Dose 3 — Moderna
2021-10-31
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Vomiting

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2021-11-03
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-04
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Diarrhea

Adult check-in
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Chills, Muscle or body aches

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2022-01-30
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-30
Dose 4 — Moderna
2022-04-15
Survey response — day 14, dose 4
MedDRA: Office visit, Oral lichen planus — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Oral Lichen Planus · Healthcare visit (other): Ent in 2021

MedDRA releases: 2024-11 · check-in free text available
2022-04-15
Report sent to call center — day 14, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-04-20
Survey response — day 21, dose 4
MedDRA: Eye haemorrhage, Office visit — Feeling: Fair

Free text: At annual eye exam they noticed blood behind right eye. Eye Dr sending message to PMC.

MedDRA releases: 2024-11 · check-in free text available
2022-04-21
Call successful
Not applicable - Accidental Reporting
2022-04-27
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2022-05-04
Survey response — day 35, dose 4
MedDRA: Blood glucose increased, Office visit, Retinal haemorrhage — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Borderline high sugar H1C went to doc because of blood found behind right retina. All is ok. · Healthcare visit (other): Dr office

MedDRA releases: 2024-11 · check-in free text available
2022-05-04
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-05
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-28
Survey response — 6 months, dose 4
MedDRA: Chest discomfort, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Weird chest sensations. · Healthcare visit (other): Will see Dr/Cardiologist tomorrow.

MedDRA releases: 2024-11 · check-in free text available
2022-09-28
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2022-09-29
Call 1 — Left Voicemail
2023-03-30
Health check-in — 12 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-22	Moderna
2	2021-02-19	Moderna
3	2021-10-31	Moderna	No
4	2022-03-30	Moderna	No

Call center

3 call center cases

2 successful · 1 unsuccessful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-25

Systemic reaction (other): My eyes feel weird.

2021-01-26

Systemic reaction (other): My temperature was 98.8.

2021-01-28

Systemic reaction (other): I have a small bruise by the injection sight. I also have a rash on my face but I had it before the vaccine

Release 4 — days 1–6 daily, dose 2

2021-02-22

Systemic reaction (other): Feeling congested but it is allergy season perhaps.

Release 11 — day 14, dose 4

2022-04-15

Symptoms: Oral Lichen Planus

Healthcare visit (other): Ent in 2021

Release 11 — day 21, dose 4

2022-04-20

Symptoms: At annual eye exam they noticed blood behind right eye. Eye Dr sending message to PMC.

Release 11 — day 35, dose 4

2022-05-04

Symptoms: Borderline high sugar H1C went to doc because of blood found behind right retina. All is ok.

Healthcare visit (other): Dr office

Release 12 — 6 months, dose 4

2022-09-28

Symptoms: Weird chest sensations.

Healthcare visit (other): Will see Dr/Cardiologist tomorrow.

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	Blood glucose increased	·	·	✓
SD	Chest discomfort	·	·	✓
SD	Eye haemorrhage	·	·	✓
SD	Office visit	·	·	✓
SD	Oral lichen planus	·	·	✓
SD	Retinal haemorrhage	·	·	✓
SRO	Body temperature increased	✓	✓	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Ocular discomfort	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Seasonal allergy	✓	✓	✓

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