68M-10919-04393

4 vaccinations 17 coded responses 45 check-ins 16 free-text entries 4 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 207 / MD
Registered: 2021-04-08

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Registered dependents

CBZ-18763-56184 Child or adolescent in my care · Male · 2021-11-20

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-06
Dose 1 — Moderna
2021-04-08
Registered in v-safe
2021-04-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea

Adult check-in
2021-04-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-10
Survey response — days 1–6 daily, dose 1
MedDRA: Fatigue — Feeling: Fair · Fatigue or tiredness

Free text: I have my period I think my fatigue is related to that.

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

Adult check-in
2021-04-15
Health check-in — day 7, dose 1
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-04-20
Survey response — day 14, dose 1
MedDRA: Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling — Feeling: Good · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: From 4/14-4/19 I had an itchy red rash, swelling, and pain at the injection site, and swelling and pain extending into my underarm and upper breast area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-20
Report sent to call center — day 14, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-27
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-06
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-05-11
Dose 2 — Moderna
2021-05-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Swelling, Itching · None

Adult check-in
2021-05-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-05-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-05-18
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-05-25
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-06-01
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-08
Survey response — day 28, dose 2
MedDRA: Headache, Insomnia — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Persistent headache & difficulty sleeping

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-15
Survey response — day 35, dose 2
MedDRA: Insomnia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Trouble sleeping likely unrelated

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-22
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-08-10
Survey response — 3 months, dose 2
MedDRA: Anaemia folate deficiency — Feeling: Good · 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

Free text: Anemia due to folate deficiency

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-10
Report sent to call center — 3 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

1 call case(s)
2021-08-16
Call 1 — Left Voicemail
2021-11-09
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-19
Dose 3 — Moderna
2021-11-20
Survey response — days 1–6 daily, dose 3
MedDRA: Brain fog — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Brain fog

MedDRA releases: 2024-11 · check-in free text available
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Adult check-in
2021-11-22
Survey response — days 1–6 daily, dose 3
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Fatigue or tiredness

Free text: Tender, swollen gland in my underarm (near the injection site)

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain

Free text: Swollen gland in underarm

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — day 7, dose 3
Feeling: Fair · None

Adult check-in
2021-12-03
Survey response — day 14, dose 3
MedDRA: Fatigue, Nausea, Pyrexia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Nausea, fatigue, fever

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Survey response — day 21, dose 3
MedDRA: Dysmenorrhoea, Heavy menstrual bleeding — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Especially painful, heavy period

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Health check-in — day 28, dose 3
Feeling: Poor

Adult check-in
2021-12-26
Survey response — day 35, dose 3
MedDRA: Dizziness, Fatigue — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Fatigue & lightheadedness

MedDRA releases: 2024-11 · check-in free text available
2021-12-31
Survey response — day 42, dose 3
MedDRA: Ear pain, Oropharyngeal pain — Feeling: Poor

Free text: Achy throat and ears

MedDRA releases: 2024-11 · check-in free text available
2022-02-18
Survey response — 3 months, dose 3
MedDRA: Oropharyngeal pain, Pyrexia — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Sore throat, fever

MedDRA releases: 2024-11 · check-in free text available
2022-02-18
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-02-24
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-24
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-02-24
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-05-20
Health check-in — 6 months, dose 3
Feeling: Poor

Adult check-in
2022-11-13
Dose 4 — Moderna
2022-11-19
Survey response — 12 months, dose 3
MedDRA: Headache, Muscle spasms — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Headache, severe cramps

MedDRA releases: 2024-11 · check-in free text available
2022-11-19
Survey response — days 1–6 daily, dose 4
MedDRA: Dysmenorrhoea — Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness · Be unable to work or attend school

Free text: Severe menstrual cramps

MedDRA releases: 2024-11 · check-in free text available
2022-11-22
Survey response — day 7, dose 4
MedDRA: Dysmenorrhoea, Heavy menstrual bleeding — Feeling: Fair · Be unable to do your normal daily activities

Free text: Severe menstrual cramps & heavier bleeding

MedDRA releases: 2024-11 · check-in free text available
2022-11-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-12-04
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-12-11
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-12-18
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-25
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-02-12
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-05-14
Survey response — 6 months, dose 4
MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-05-14
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-05-15
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-06	Moderna
2	2021-05-11	Moderna
3	2021-11-19	Moderna	No
4	2022-11-13	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-10

Systemic reaction (other): I have my period I think my fatigue is related to that.

Release 7 — day 14, dose 1

2021-04-20

Symptoms: From 4/14-4/19 I had an itchy red rash, swelling, and pain at the injection site, and swelling and pain extending into my underarm and upper breast area.

Release 8 — day 28, dose 2

2021-06-08

Symptoms: Persistent headache & difficulty sleeping

Release 9 — day 35, dose 2

2021-06-15

Symptoms: Trouble sleeping likely unrelated

Release 9 — 3 months, dose 2

2021-08-10

Symptoms: Anemia due to folate deficiency

Release 10 — days 1–6 daily, dose 3

2021-11-20

Systemic reaction (other): Brain fog

2021-11-22

Systemic reaction (other): Tender, swollen gland in my underarm (near the injection site)

2021-11-23

Systemic reaction (other): Swollen gland in underarm

Release 10 — day 14, dose 3

2021-12-03

Symptoms: Nausea, fatigue, fever

Release 10 — day 21, dose 3

2021-12-10

Symptoms: Especially painful, heavy period

Release 10 — day 35, dose 3

2021-12-26

Symptoms: Fatigue & lightheadedness

Release 10 — day 42, dose 3

2021-12-31

Symptoms: Achy throat and ears

Release 11 — 3 months, dose 3

2022-02-18

Symptoms: Sore throat, fever

Release 12 — 12 months, dose 3

2022-11-19

Symptoms: Headache, severe cramps

Release 12 — days 1–6 daily, dose 4

2022-11-19

Systemic reaction (other): Severe menstrual cramps

Release 12 — day 7, dose 4

2022-11-22

Systemic reaction (other): Severe menstrual cramps & heavier bleeding

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	Anaemia folate deficiency	✓	·	✓
SD	Dizziness	·	·	✓
SD	Dysmenorrhoea	·	·	✓
SD	Ear pain	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	✓	✓	✓
SD	Heavy menstrual bleeding	·	·	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Injection site swelling	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Lymph node pain	·	·	✓
SD	Lymphadenopathy	·	·	✓
SD	Muscle spasms	·	·	✓
SD	Nausea	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pyrexia	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Dysmenorrhoea	·	·	✓
SRO	Fatigue	✓	✓	✓
SRO	Heavy menstrual bleeding	·	·	✓
SRO	Lymph node pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓

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