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69M-19179-99689

4 vaccinations 11 coded responses 44 check-ins 11 free-text entries 0 call cases
Sex
Female
Age at first dose
61-65
ZIP prefix
959 / CA
Registered
2021-03-16
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-03-16
    Registered in v-safe
  2. 2021-03-16
    Dose 1 — Moderna
  3. 2021-03-16
    Health check-in — day 0, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  4. 2021-03-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Fatigue or tiredness
    Adult check-in
  5. 2021-03-18
    Survey response — days 1–6 daily, dose 1
    MedDRA: Chills, Headache, Nausea, Self-medication — Feeling: Good · Site: Pain · Fatigue or tiredness
    Free text: Last evening felt slight queasy, headache, chills but Tylenol helped it disperse
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-03-19
    Survey response — days 1–6 daily, dose 1
    MedDRA: Axillary pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Tenderness in armpit same side as injection site
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-03-20
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness
    Adult check-in
  8. 2021-03-21
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  9. 2021-03-22
    Survey response — days 1–6 daily, dose 1
    MedDRA: Depression, Fatigue — Feeling: Fair · Fatigue or tiredness
    Free text: Probably just tired from being depressed. No other symptoms.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-03-23
    Health check-in — day 7, dose 1
    Feeling: Fair · Fatigue or tiredness
    Adult check-in
  11. 2021-03-30
    Health check-in — day 14, dose 1
    Feeling: Fair
    Adult check-in
  12. 2021-04-06
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-04-13
    Dose 2 — Moderna
  14. 2021-04-13
    Survey response — day 0, dose 2
    MedDRA: No adverse event — Feeling: Good · Site: Pain
    Free text: None at present
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-04-14
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  16. 2021-04-15
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  17. 2021-04-17
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-04-18
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Fatigue or tiredness
    Adult check-in
  19. 2021-04-20
    Health check-in — day 7, dose 2
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  20. 2021-04-27
    Survey response — day 14, dose 2
    MedDRA: Oropharyngeal pain — Feeling: Good
    Free text: Touch of sore throat, sl fever 99.7
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-05-04
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-05-11
    Survey response — day 28, dose 2
    MedDRA: Ear pain, Lacrimation increased, Oropharyngeal pain, Tenderness, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Left ear and side of throat sore especially when I swallow. Both eyes especially Left eye very weepy and watery down cheek and tender. Blurry vision. Do not know if any connection to vaccine, seeing eye doctor on Thursday.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  23. 2021-05-18
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-05-25
    Survey response — day 42, dose 2
    MedDRA: Balance disorder, Fatigue, Gait disturbance — Feeling: Fair
    Free text: Feel off balance when up and walking especially when up I. Night and morning but have to correct my gait occasionally. Tired. These could be from other reasons or medication so not sure. Im retired so dont work anyway.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  25. 2021-07-13
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-10-12
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-11-30
    Dose 3 — Moderna
  28. 2021-12-22
    Survey response — day 21, dose 3
    MedDRA: Cough, Laryngitis, Lower respiratory tract infection, SARS-CoV-2 test negative — Feeling: Good
    Free text: Came down with a chest cold and laryngitis with a cough when I was visiting my daughter in Maine. I took a rapid covid test and it was negative. I got better and after I was well I got my booster (3rd) vaccine while in Maine. Was there for a month.
    MedDRA releases: 2024-11 · check-in free text available
  29. 2021-12-28
    Survey response — day 28, dose 3
    MedDRA: Abdominal pain upper — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Stomach hurts but don't know if it's related to the vaccine.
    MedDRA releases: 2024-11 · check-in free text available
  30. 2022-01-04
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  31. 2022-01-11
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  32. 2022-03-01
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  33. 2022-05-10
    Dose 4 — Moderna
  34. 2022-05-10
    Health check-in — day 0, dose 4
    Feeling: Good · None
    Adult check-in
  35. 2022-05-11
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  36. 2022-05-12
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Site: Redness · None
    Adult check-in
  37. 2022-05-13
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Site: Redness · None
    Adult check-in
  38. 2022-05-14
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  39. 2022-05-15
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  40. 2022-05-16
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  41. 2022-05-17
    Health check-in — day 7, dose 4
    Feeling: Good · None
    Adult check-in
  42. 2022-05-24
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  43. 2022-05-31
    Survey response — day 21, dose 4
    MedDRA: Abdominal pain upper, Asthenia, Headache, Poor quality sleep, SARS-CoV-2 test negative — Feeling: Good
    Free text: Yesterday felt weak, stomach hurt and slightly headachy but had not slept well the night before. I took a Covid test and it was negative. Fine today.
    MedDRA releases: 2024-11 · check-in free text available
  44. 2022-06-07
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  45. 2022-06-14
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  46. 2022-06-21
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  47. 2022-08-09
    Survey response — 3 months, dose 4
    MedDRA: Body temperature increased, Chest discomfort, Dizziness, Fatigue, Nasopharyngitis, Oropharyngeal pain, Pain, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Felt cold like symptoms. Tinge of sore throat. Did a Covid test and was negative. Lungs felt a bit tight. Two days later took another test and showed positive. Just a bit tired. Occasional light headed, occasionally aches, temp no higher than 99.8
    MedDRA releases: 2024-11 · check-in free text available
  48. 2022-11-10
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  49. 2023-05-10
    Health check-in — 12 months, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-03-16Moderna
22021-04-13Moderna
32021-11-30Moderna No
42022-05-10Moderna No

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-18

Systemic reaction (other): Last evening felt slight queasy, headache, chills but Tylenol helped it disperse

2021-03-19

Systemic reaction (other): Tenderness in armpit same side as injection site

Release 6 — days 1–6 daily, dose 1

2021-03-22

Systemic reaction (other): Probably just tired from being depressed. No other symptoms.

Release 7 — day 0, dose 2

2021-04-13

Systemic reaction (other): None at present

Release 8 — day 14, dose 2

2021-04-27

Symptoms: Touch of sore throat, sl fever 99.7

Release 8 — day 28, dose 2

2021-05-11

Symptoms: Left ear and side of throat sore especially when I swallow. Both eyes especially Left eye very weepy and watery down cheek and tender. Blurry vision. Do not know if any connection to vaccine, seeing eye doctor on Thursday.

Release 8 — day 42, dose 2

2021-05-25

Symptoms: Feel off balance when up and walking especially when up I. Night and morning but have to correct my gait occasionally. Tired. These could be from other reasons or medication so not sure. Im retired so dont work anyway.

Release 10 — day 21, dose 3

2021-12-22

Symptoms: Came down with a chest cold and laryngitis with a cough when I was visiting my daughter in Maine. I took a rapid covid test and it was negative. I got better and after I was well I got my booster (3rd) vaccine while in Maine. Was there for a month. cut off by CDC

Release 10 — day 28, dose 3

2021-12-28

Symptoms: Stomach hurts but don't know if it's related to the vaccine.

Release 11 — day 21, dose 4

2022-05-31

Symptoms: Yesterday felt weak, stomach hurt and slightly headachy but had not slept well the night before. I took a Covid test and it was negative. Fine today.

Release 12 — 3 months, dose 4

2022-08-09

Symptoms: Felt cold like symptoms. Tinge of sore throat. Did a Covid test and was negative. Lungs felt a bit tight. Two days later took another test and showed positive. Just a bit tired. Occasional light headed, occasionally aches, temp no higher than 99.8

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

FieldPreferred term2021-092023-042024-11
SDAbdominal pain upper · · ✓
SDAsthenia · · ✓
SDBalance disorder ✓ ✓ ✓
SDBody temperature increased · · ✓
SDChest discomfort · · ✓
SDCough · · ✓
SDDizziness · · ✓
SDEar pain ✓ ✓ ✓
SDFatigue ✓ ✓ ✓
SDGait disturbance ✓ ✓ ✓
SDHeadache · · ✓
SDLacrimation increased ✓ ✓ ✓
SDLaryngitis · · ✓
SDLower respiratory tract infection · · ✓
SDNasopharyngitis · · ✓
SDOropharyngeal pain ✓ ✓ ✓
SDPain · · ✓
SDPoor quality sleep · · ✓
SDSARS-CoV-2 test negative · · ✓
SDSARS-CoV-2 test positive · · ✓
SDTenderness ✓ ✓ ✓
SDVision blurred ✓ ✓ ✓
SROAxillary pain ✓ ✓ ✓
SROChills ✓ ✓ ✓
SRODepression ✓ ✓ ✓
SROFatigue ✓ ✓ ✓
SROHeadache ✓ ✓ ✓
SRONausea ✓ ✓ ✓
SRONo adverse event ✓ ✓ ✓
SROSelf-medication ✓ ✓ ✓

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

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