6CU-21064-49777

3 vaccinations 8 coded responses 14 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 032 / NH
Registered: 2021-04-21

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

2021-03-24
Dose 1 — Moderna
2021-04-19
Dose 2 — Moderna
2021-04-21
Registered in v-safe
2021-04-21
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Shot was 2 days ago. Symptoms and degrees varied between both days & x of day. My reporting is based on today only. Ok?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Survey response — days 1–6 daily, dose 2
MedDRA: Flatulence — Feeling: Fair · Fever · Joint pains, Fatigue or tiredness, Abdominal pain

Free text: Foul smelling gas, w/out eating anything out of the ordinary....

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fever · Headache, Joint pains, Diarrhea

Adult check-in
2021-04-25
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Poor · Fever · Headache, Joint pains, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: I have had swollen glands off and on all 7 days and forgot to put that down.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-26
Survey response — day 7, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Fever · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Swollen lymph glands in neck

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-03
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-10
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-24
Survey response — day 35, dose 2
MedDRA: Axillary pain, Breast pain, Burning sensation, Pruritus — Feeling: Fair

Free text: Sore/achey breasts and under upper arms and arm pits, somex burning feeling, somex itchy - all intermittent not continuous, but throughout the day. Same stuff happened a couple weeks back but to a lesser degree so I didn't think too much of it. But

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-06
Survey response — day 42, dose 2
MedDRA: Axillary pain, Burning sensation — Feeling: Fair

Free text: I answ'd the first x u sent this 6 week survey; but it didn't have an I don't know response for 1 of the ?'s ....I have no idea if the symptoms r related to vaccine. I'm just reporting all things new.Burning & painful under arms & breasts-10 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-19
Survey response — 3 months, dose 2
MedDRA: Asthma, Cough, Diarrhoea, Headache, Office visit, Oropharyngeal pain — 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

Free text: Symptoms: Cough, sore throat, headache, diarrhea, asthma · Healthcare visit (other): I found my primary to see if I needed to have a covid test before I go in for my annual physical in 2 days into days.

MedDRA releases: 2024-11 · check-in free text available
2021-07-19
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)
2021-07-26
Call 1 — Left Voicemail
2021-10-20
Survey response — 6 months, dose 2
MedDRA: Asthma, Cough, Office visit, Oxygen saturation decreased, Pre-existing disease — 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: Symptoms: My asthma is much worse, every day now. prev 15 d/yr 02 down to 80-83 for 12 hours 1 day. (Rapid test was negative even w/ horrific cough.) O2 often in the low 90's now. They have added 2 new meds to help me & a consult with an allergist this week. · Healthcare visit (other): & my PCP 3x

MedDRA releases: 2024-11 · check-in free text available
2021-10-20
Report sent to call center — 6 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 · 1 call case(s)
2021-10-22
Call 2 — Left Voicemail
2021-12-16
Dose 3 — Moderna
2022-01-12
Call 1 — Could Not Reach Participant
2022-04-20
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-12-17
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-24	Moderna
2	2021-04-19	Moderna
3	2021-12-16	Moderna	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-21

Systemic reaction (other): Shot was 2 days ago. Symptoms and degrees varied between both days & x of day. My reporting is based on today only. Ok?

2021-04-23

Systemic reaction (other): Foul smelling gas, w/out eating anything out of the ordinary....

2021-04-25

Systemic reaction (other): I have had swollen glands off and on all 7 days and forgot to put that down.

Release 8 — day 7, dose 2

2021-04-26

Systemic reaction (other): Swollen lymph glands in neck

Release 8 — day 35, dose 2

2021-05-24

Symptoms: Sore/achey breasts and under upper arms and arm pits, somex burning feeling, somex itchy - all intermittent not continuous, but throughout the day. Same stuff happened a couple weeks back but to a lesser degree so I didn't think too much of it. But cut off by CDC

Release 8 — day 42, dose 2

2021-06-06

Symptoms: I answ'd the first x u sent this 6 week survey; but it didn't have an I don't know response for 1 of the ?'s ....I have no idea if the symptoms r related to vaccine. I'm just reporting all things new.Burning & painful under arms & breasts-10 days

Release 9 — 3 months, dose 2

2021-07-19

Symptoms: Cough, sore throat, headache, diarrhea, asthma

Healthcare visit (other): I found my primary to see if I needed to have a covid test before I go in for my annual physical in 2 days into days.

Release 10 — 6 months, dose 2

2021-10-20

Symptoms: My asthma is much worse, every day now. prev 15 d/yr 02 down to 80-83 for 12 hours 1 day. (Rapid test was negative even w/ horrific cough.) O2 often in the low 90's now. They have added 2 new meds to help me & a consult with an allergist this week. cut off by CDC

Healthcare visit (other): & my PCP 3x

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	Asthma	·	·	✓
SD	Axillary pain	✓	✓	✓
SD	Breast pain	✓	✓	✓
SD	Burning sensation	✓	✓	✓
SD	Cough	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Headache	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Oxygen saturation decreased	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Flatulence	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓

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