6EX-21485-65788

3 vaccinations 7 coded responses 12 check-ins 7 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 275 / NC
Registered: 2021-04-18

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

2021-03-17
Dose 1 — Moderna
2021-04-14
Dose 2 — Moderna
2021-04-18
Registered in v-safe
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-23
Survey response — day 7, dose 2
MedDRA: Hypersensitivity — Feeling: Fair · Nausea

Free text: Allergies since 2nd dose, atypical for me

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

Free text: Ongoing- slightly increase in usually slightly swollen neck lymph nodes.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-27
Dose 3 — Moderna
2021-11-07
Survey response — day 7, dose 3
MedDRA: Arthralgia, Asthenia, Back pain, Musculoskeletal pain, Neuralgia, Sciatica — Feeling: Poor · Fever · Joint pains, Muscle or body aches · Be unable to do your normal daily activities

Free text: Siatica, debilitating pain- lower left back to left butt through nerves and hip joint

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Health check-in — day 14, dose 3
Feeling: Poor

Adult check-in
2021-11-19
Survey response — day 21, dose 3
MedDRA: Arthralgia, Back pain, Gait disturbance, Myalgia, Office visit, Pain, Pre-existing disease, Self-medication, Sitting disability — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Left lower back pain moved more to left hip and now it is radiating through my left leg muscles. It has been hard to sit long or walk long. I have had to take 600 mg ibprofen around the clock. I do have some mild preexisting conditions. bone misalign · Healthcare visit (other): And chiropractor

MedDRA releases: 2024-11 · check-in free text available
2021-11-19
Report sent to call center — day 21, 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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-11-23
Call 1 — Left Voicemail
2021-11-24
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-03
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-08
Survey response — day 42, dose 3
MedDRA: Muscular weakness, Myalgia, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: The left hip joint with weak tender muscle symptoms got worse with more use (but overall is slowly getting better). · Healthcare visit (other): I am scheduled with physical therapy this month.

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Report sent to call center — day 42, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2021-12-09
Call 1 — Left Voicemail
2022-01-26
Survey response — 3 months, dose 3
MedDRA: COVID-19, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Got mild covid, positive test was from 1/18 rapid test.

MedDRA releases: 2024-11 · check-in free text available
2022-04-29
Survey response — 6 months, dose 3
MedDRA: Condition aggravated, Pre-existing disease, Stress — Feeling: Fair · Be unable to do your normal daily activities

Free text: Seemingly previous asymptomatic Hpv now worsened significantly. Aggravated by stress only?

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-17	Moderna
2	2021-04-14	Moderna
3	2021-10-27	Moderna	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 7 — day 7, dose 2

2021-04-23

Systemic reaction (other): Allergies since 2nd dose, atypical for me

Release 8 — day 14, dose 2

2021-05-03

Symptoms: Ongoing- slightly increase in usually slightly swollen neck lymph nodes.

Release 10 — day 7, dose 3

2021-11-07

Systemic reaction (other): Siatica, debilitating pain- lower left back to left butt through nerves and hip joint

Release 10 — day 21, dose 3

2021-11-19

Symptoms: Left lower back pain moved more to left hip and now it is radiating through my left leg muscles. It has been hard to sit long or walk long. I have had to take 600 mg ibprofen around the clock. I do have some mild preexisting conditions. bone misalign cut off by CDC

Healthcare visit (other): And chiropractor

Release 10 — day 42, dose 3

2021-12-08

Symptoms: The left hip joint with weak tender muscle symptoms got worse with more use (but overall is slowly getting better).

Healthcare visit (other): I am scheduled with physical therapy this month.

Release 11 — 3 months, dose 3

2022-01-26

Symptoms: Got mild covid, positive test was from 1/18 rapid test.

Release 11 — 6 months, dose 3

2022-04-29

Symptoms: Seemingly previous asymptomatic Hpv now worsened significantly. Aggravated by stress only?

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	Arthralgia	·	·	✓
SD	Back pain	·	·	✓
SD	Condition aggravated	·	·	✓
SD	COVID-19	·	·	✓
SD	Gait disturbance	·	·	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Muscular weakness	·	·	✓
SD	Myalgia	·	·	✓
SD	Pain	·	·	✓
SD	Pre-existing disease	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Self-medication	·	·	✓
SD	Sitting disability	·	·	✓
SD	Stress	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Asthenia	·	·	✓
SRO	Back pain	·	·	✓
SRO	Hypersensitivity	✓	✓	✓
SRO	Musculoskeletal pain	·	·	✓
SRO	Neuralgia	·	·	✓
SRO	Sciatica	·	·	✓

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