6GZ-30133-00648

4 vaccinations 7 coded responses 32 check-ins 6 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 803 / CO
Registered: 2021-03-04

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

2021-03-04
Registered in v-safe
2021-03-04
Dose 1 — Moderna
2021-03-04
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-06
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease — Feeling: Good

Free text: I am an untreated ppd conversion from 1970. TB walled off in my lungs. Any implications for corona virus or vaccine for me from old Hx TB exposure and ?TB antibodies?

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-18
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-02
Dose 2 — Moderna
2021-04-02
Health check-in — day 0, dose 2
Feeling: Good · Diarrhea

Adult check-in
2021-04-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Nausea, Abdominal pain

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Adult check-in
2021-04-07
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Breast pain, Flank pain — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Mostly axillary and right breast and side aches spots

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-08
Survey response — days 1–6 daily, dose 2
MedDRA: Tenderness — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Above is tender spot r axillary and right greats of injection side, decreasing each day but still present.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-09
Survey response — day 7, dose 2
MedDRA: Lymph node pain — Feeling: Good

Free text: Right (injection side) axillary tenderness continues to decrease but still present

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-23
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-07
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-14
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-02
Survey response — 3 months, dose 2
MedDRA: Injection site pain, Middle insomnia, Myalgia, Pain, Pre-existing disease — Feeling: Good

Free text: New aching of upper biceps, wakens me at night, pains occur at rest and increase with initial movements, then recede as if loosening up. But it is distinctly muscles around injection sites, not my aching joints. I suspect it is my 70 years of age.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-01
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-03
Dose 3 — Pfizer-BioNTech
Co-administered: Flu
2022-04-02
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-04-04
Dose 4 — Pfizer-BioNTech
2022-04-28
Survey response — day 21, dose 4
MedDRA: Arthralgia, Pain, Pain in extremity, Pyrexia — Feeling: Good · Be unable to do your normal daily activities

Free text: For 1 day post vac fever and achey, then fine. Shoulder bicep area aches continue intermittently.

MedDRA releases: 2024-11 · check-in free text available
2022-05-02
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-09
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-16
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-07-04
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-04
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in
2023-04-04
Survey response — 12 months, dose 4
MedDRA: COVID-19, Gastrointestinal disorder, Illness, Respiratory disorder, Sinusitis — Feeling: Good · 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

MedDRA releases: 2024-11
2023-04-04
Report sent to call center — 12 months, dose 4
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 · 1 call case(s)
2023-04-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-04	Moderna
2	2021-04-02	Moderna
3	2021-11-03	Pfizer-BioNTech	Flu
4	2022-04-04	Pfizer-BioNTech	No

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-06

Systemic reaction (other): I am an untreated ppd conversion from 1970. TB walled off in my lungs. Any implications for corona virus or vaccine for me from old Hx TB exposure and ?TB antibodies?

Release 7 — days 1–6 daily, dose 2

2021-04-07

Systemic reaction (other): Mostly axillary and right breast and side aches spots

2021-04-08

Systemic reaction (other): Above is tender spot r axillary and right greats of injection side, decreasing each day but still present.

Release 7 — day 7, dose 2

2021-04-09

Systemic reaction (other): Right (injection side) axillary tenderness continues to decrease but still present

Release 9 — 3 months, dose 2

2021-07-02

Symptoms: New aching of upper biceps, wakens me at night, pains occur at rest and increase with initial movements, then recede as if loosening up. But it is distinctly muscles around injection sites, not my aching joints. I suspect it is my 70 years of age. cut off by CDC

Release 11 — day 21, dose 4

2022-04-28

Symptoms: For 1 day post vac fever and achey, then fine. Shoulder bicep area aches continue intermittently.

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	Arthralgia	·	·	✓
SD	COVID-19	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Illness	·	·	✓
SD	Injection site pain	✓	✓	✓
SD	Middle insomnia	✓	✓	✓
SD	Myalgia	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Pain in extremity	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pyrexia	·	·	✓
SD	Respiratory disorder	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Axillary pain	✓	✓	✓
SRO	Breast pain	✓	✓	✓
SRO	Flank pain	✓	✓	✓
SRO	Lymph node pain	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Tenderness	✓	✓	✓

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