6LQ-17031-88393

3 vaccinations 12 coded responses 38 check-ins 12 free-text entries 0 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 274 / NC
Registered: 2021-03-15

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

GYH-24084-04112 Child or adolescent in my care · Female · 2022-06-29

3A3-27015-26821 Child or adolescent in my care · Female · 2022-06-29

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-03-15
Registered in v-safe
2021-03-15
Dose 1 — Moderna
2021-03-15
Survey response — day 0, dose 1
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: lightheadedness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Fatigue or tiredness, Nausea

Adult check-in
2021-03-18
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal — Feeling: Fair · Fatigue or tiredness, Nausea, Abdominal pain

Free text: brain fog

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness, Nausea

Adult check-in
2021-03-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-29
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site pruritus, Injection site warmth, Rash papular, Urticaria — Feeling: Good

Free text: Moderna arm itchy, warm, large red welt on arm at injection site and raised rash.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-12
Dose 2 — Moderna
2021-04-12
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · Fatigue or tiredness

Adult check-in
2021-04-17
Survey response — days 1–6 daily, dose 2
MedDRA: Immunisation reaction, Palpitations — Feeling: Fair · Site: Redness · Fatigue or tiredness

Free text: Moderna arm (last severe than last time), heart palpitations

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness, Abdominal pain

Adult check-in
2021-04-21
Health check-in — day 7, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-26
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-03
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-10
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-17
Survey response — day 35, dose 2
MedDRA: Rash — Feeling: Good

Free text: small rash on both arms. may not be related but reporting just in case.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-24
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-14
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-19
Dose 3 — Moderna
Co-administered: Flu
2021-11-21
Survey response — days 1–6 daily, dose 3
MedDRA: Palpitations — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea

Free text: heart palpitation

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Headache

Adult check-in
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Itching · Fatigue or tiredness

Adult check-in
2021-11-25
Survey response — days 1–6 daily, dose 3
MedDRA: Palpitations — Feeling: Good

Free text: heart palpitations

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-05
Survey response — day 14, dose 3
MedDRA: Fatigue, Nasopharyngitis, Pain, Respiratory tract congestion — Feeling: Fair · Be unable to do your normal daily activities

Free text: head cold (congestion, fatigue, aches)

MedDRA releases: 2024-11 · check-in free text available
2021-12-10
Survey response — day 21, dose 3
MedDRA: Bronchitis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: bronchitis

MedDRA releases: 2024-11 · check-in free text available
2021-12-17
Survey response — day 28, dose 3
MedDRA: Atrial fibrillation — Feeling: Good

Free text: afib (may be due to anxiety; reporting just in case)

MedDRA releases: 2024-11 · check-in free text available
2021-12-24
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-31
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-02-20
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-22
Survey response — 6 months, dose 3
MedDRA: Anxiety, Menstrual disorder — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Changes to menstrual cycle, increased anxiety.

MedDRA releases: 2024-11 · check-in free text available
2022-11-19
Survey response — 12 months, dose 3
MedDRA: Bronchitis — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Bronchitis

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

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-15	Moderna
2	2021-04-12	Moderna
3	2021-11-19	Moderna	Flu

Free text

Release 5 — day 0, dose 1

2021-03-15

Systemic reaction (other): lightheadedness

Release 5 — days 1–6 daily, dose 1

2021-03-18

Systemic reaction (other): brain fog

Release 6 — day 14, dose 1

2021-03-29

Symptoms: Moderna arm itchy, warm, large red welt on arm at injection site and raised rash.

Release 7 — days 1–6 daily, dose 2

2021-04-17

Systemic reaction (other): Moderna arm (last severe than last time), heart palpitations

Release 8 — day 35, dose 2

2021-05-17

Symptoms: small rash on both arms. may not be related but reporting just in case.

Release 10 — days 1–6 daily, dose 3

2021-11-21

Systemic reaction (other): heart palpitation

2021-11-25

Systemic reaction (other): heart palpitations

Release 10 — day 14, dose 3

2021-12-05

Symptoms: head cold (congestion, fatigue, aches)

Release 10 — day 21, dose 3

2021-12-10

Symptoms: bronchitis

Release 10 — day 28, dose 3

2021-12-17

Symptoms: afib (may be due to anxiety; reporting just in case)

Release 11 — 6 months, dose 3

2022-05-22

Symptoms: Changes to menstrual cycle, increased anxiety.

Release 12 — 12 months, dose 3

2022-11-19

Symptoms: Bronchitis

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	Anxiety	·	·	✓
SD	Atrial fibrillation	·	·	✓
SD	Bronchitis	·	·	✓
SD	Fatigue	·	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site warmth	✓	✓	✓
SD	Menstrual disorder	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pain	·	·	✓
SD	Rash	✓	✓	✓
SD	Rash papular	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Urticaria	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Immunisation reaction	·	·	✓
SRO	Palpitations	✓	✓	✓

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