6D2-23810-27093

3 vaccinations 11 coded responses 26 check-ins 11 free-text entries 0 call cases

Sex: Female
Age at first dose: 61-65
ZIP prefix: 120 / NY
Registered: 2021-02-13

Relationship: Self
Race: White
Ethnicity: N/A

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-02-12
Dose 1 — Moderna
2021-02-13
Registered in v-safe
2021-02-14
Survey response — days 1–6 daily, dose 1
MedDRA: Unevaluable event — Feeling: Fair · Headache, Muscle or body aches

Free text: My dog pulled me off the ground Saturday. I split open my and bled from my head and smached and sprained my wrist. My neck and occipital lobe is excruciatingly sore. Not your fault.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Survey response — days 1–6 daily, dose 1
MedDRA: Headache, Injection site pain, Self-medication — Feeling: Fair · Headache, Muscle or body aches

Free text: My dog lunged toward a target and pulled me off my feet. I cracked my head on pavement it bled for an hour, Now is swollen and giving me temporal headaches...from Saturday at around 3pm. Have been taking Alleve 220mg tabs since but still have tenderness at site and HA's.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-16
Survey response — days 1–6 daily, dose 1
MedDRA: Adverse reaction — Feeling: Fair · Headache, Muscle or body aches

Free text: From fall. Otherwise am good

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Survey response — days 1–6 daily, dose 1
MedDRA: Brain oedema, Fall, Myalgia, Pain, Skin abrasion — Feeling: Good · Headache, Muscle or body aches

Free text: My head is slightly better there are two areas of abrasion and the occipital lobe is starting to go down in swelling with occasional sharp pain. All I think from fall. My neck and stomach muscles are less painfully also. Thank you.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 1
MedDRA: Concussion, Headache, Tenderness — Feeling: Fair · Headache

Free text: Headache from concussion, on Saturday. Causing sharp pain in various parts of head and tenderness in occipital posterior area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — day 7, dose 1
MedDRA: Fall, Headache, Pain — Feeling: Good · Headache

Free text: Am feeling better only slight headache and pain from fall.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-28
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-12
Dose 2 — Moderna
2021-03-12
Health check-in — day 0, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Abdominal pain

Adult check-in
2021-03-14
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal pain, Body temperature decreased — Feeling: Good · Site: Pain · Diarrhea, Abdominal pain

Free text: 96.6 temp but feel very hot. Last night terrible abdominal pain. Better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Abdominal pain

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Abdominal pain

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 2
MedDRA: Abdominal discomfort, Abdominal pain upper — Feeling: Fair

Free text: Took Dicyclomine 10 mg ...to calm stomach last night and feel better. Slight pain now...

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — day 7, dose 2
Feeling: Fair · Headache

Adult check-in
2021-03-26
Survey response — day 14, dose 2
MedDRA: Abdominal pain, Abdominal pain upper — Feeling: Fair

Free text: Horrid stomach and abdomen pain. Tuesday-today. Went on Amoxicillin 500 mg tabs 2 bid 40 tablets. And am feeling better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — day 21, dose 2
MedDRA: Abdominal pain upper, Diarrhoea — Feeling: Good

Free text: I had terrible stomach pain and went on amoxicillin 500 mg x2 bid on 3/24 40 pills.That was after a debilitating stomach ache lasting until Monday 28 and 29th I had diarrhea. A painful time. But by Thursday the symptoms subsided and 4/2 am great!!

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-23
Survey response — day 42, dose 2
MedDRA: Abdominal pain upper, Diarrhoea, Injection site pain, Irritable bowel syndrome, Weight decreased — Feeling: Good

Free text: Spastic colon on Sunday and arm hurt at injection and lower and then diarrhea for two days and pain in stomach. Lost a couple of pounds. Very strange. But by Wednesday the symptoms were gone.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-02
Dose 3 — Moderna
Co-administered: Other
2022-03-12
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-05-03
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-02
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-12	Moderna
2	2021-03-12	Moderna
3	2021-11-02	Moderna	Other

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-14

Systemic reaction (other): My dog pulled me off the ground Saturday. I split open my and bled from my head and smached and sprained my wrist. My neck and occipital lobe is excruciatingly sore. Not your fault.

2021-02-15

Systemic reaction (other): My dog lunged toward a target and pulled me off my feet. I cracked my head on pavement it bled for an hour, Now is swollen and giving me temporal headaches...from Saturday at around 3pm. Have been taking Alleve 220mg tabs since but still have tenderness at site and HA's.

2021-02-16

Systemic reaction (other): From fall. Otherwise am good

2021-02-17

Systemic reaction (other): My head is slightly better there are two areas of abrasion and the occipital lobe is starting to go down in swelling with occasional sharp pain. All I think from fall. My neck and stomach muscles are less painfully also. Thank you.

2021-02-18

Systemic reaction (other): Headache from concussion, on Saturday. Causing sharp pain in various parts of head and tenderness in occipital posterior area.

Release 4 — day 7, dose 1

2021-02-19

Systemic reaction (other): Am feeling better only slight headache and pain from fall.

Release 5 — days 1–6 daily, dose 2

2021-03-14

Systemic reaction (other): 96.6 temp but feel very hot. Last night terrible abdominal pain. Better today.

2021-03-18

Systemic reaction (other): Took Dicyclomine 10 mg ...to calm stomach last night and feel better. Slight pain now...

Release 6 — day 14, dose 2

2021-03-26

Symptoms: Horrid stomach and abdomen pain. Tuesday-today. Went on Amoxicillin 500 mg tabs 2 bid 40 tablets. And am feeling better today.

Release 6 — day 21, dose 2

2021-04-02

Symptoms: I had terrible stomach pain and went on amoxicillin 500 mg x2 bid on 3/24 40 pills.That was after a debilitating stomach ache lasting until Monday 28 and 29th I had diarrhea. A painful time. But by Thursday the symptoms subsided and 4/2 am great!! cut off by CDC

Release 7 — day 42, dose 2

2021-04-23

Symptoms: Spastic colon on Sunday and arm hurt at injection and lower and then diarrhea for two days and pain in stomach. Lost a couple of pounds. Very strange. But by Wednesday the symptoms were gone.

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	Abdominal pain	✓	✓	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Diarrhoea	✓	✓	✓
SD	Injection site pain	✓	✓	✓
SD	Irritable bowel syndrome	✓	✓	✓
SD	Weight decreased	✓	✓	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Abdominal pain	✓	✓	✓
SRO	Abdominal pain upper	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Body temperature decreased	✓	✓	✓
SRO	Brain oedema	✓	✓	✓
SRO	Concussion	✓	✓	✓
SRO	Fall	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Self-medication	✓	✓	✓
SRO	Skin abrasion	✓	✓	✓
SRO	Tenderness	✓	✓	✓
SRO	Unevaluable event	✓	✓	✓

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