6TM-22466-00610

5 vaccinations 9 coded responses 34 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 604 / IL
Registered: 2021-01-19

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-04
Dose 1 — Moderna
2021-01-19
Registered in v-safe
2021-01-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-25
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-01
Dose 2 — Moderna
2021-02-02
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-03
Survey response — days 1–6 daily, dose 2
MedDRA: Arthralgia, Myalgia — Feeling: Good · Site: Pain, Swelling · Muscle or body aches

Free text: Yesterday after I filled out the form I had joint pains and muscle aches but ok today

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Headache

Adult check-in
2021-02-08
Survey response — day 7, dose 2
MedDRA: No adverse event — Feeling: Good · Headache

Free text: No

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-15
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-03
Survey response — 3 months, dose 2
MedDRA: Pre-existing disease — Feeling: Good · Be unable to work

Free text: I had a complete hysterectomy. But no covid

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-02
Survey response — 6 months, dose 2
MedDRA: Hysterectomy, Synovial cyst — 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, Hospitalization

Free text: Full hysterectomy, Bakers cyst, need a knee replacement

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-02
Report sent to call center — 6 months, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-16
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2021-10-15
Dose 3 — Moderna
2021-10-24
Survey response — day 7, dose 3
MedDRA: Immediate post-injection reaction, Injection site pain — Feeling: Good

Free text: I had soreness when At the site when I got the shot but not now.

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-05
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-12
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-19
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-26
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-14
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-17
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-18
Dose 4 — Moderna
2022-05-15
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2022-05-16
Survey response — day 28, dose 4
MedDRA: Nasopharyngitis, Respiratory tract congestion, Sinusitis — Feeling: Fair

Free text: Sinusitis but no fever. I am congested like a head cold.

MedDRA releases: 2024-11 · check-in free text available
2022-05-25
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-07-18
Survey response — 3 months, dose 4
MedDRA: SARS-CoV-2 test negative, Unevaluable event — Feeling: Good

Free text: The other day Fri I was very father and I went to bed. I thought I had Covid. On Sunday I took the test and it was negative.

MedDRA releases: 2024-11 · check-in free text available
2022-09-12
Dose 5 — Moderna
2022-10-01
Survey response — day 14, dose 5
MedDRA: Enteritis, Gastroenteritis viral, Urinary tract infection — 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 · Emergency room or emergency department visit

Free text: Viral gastroenteritis enteritis and urinary tract infection

MedDRA releases: 2024-11 · check-in free text available
2022-10-01
Report sent to call center — day 14, dose 5
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · 1 call case(s)
2022-10-03
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-10-04
Call 1 — Left Voicemail
2022-10-06
Call 2 — Could Not Reach Participant
2022-10-10
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-10-17
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-10-24
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2022-12-12
Health check-in — 3 months, dose 5
Feeling: Good

Adult check-in
2023-03-13
Survey response — 6 months, dose 5
MedDRA: Cerebral haemorrhage, Fall, Gastrointestinal disorder, Hospitalisation — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-04	Moderna
2	2021-02-01	Moderna
3	2021-10-15	Moderna	No
4	2022-04-18	Moderna	No
5	2022-09-12	Moderna	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 2

2021-02-03

Systemic reaction (other): Yesterday after I filled out the form I had joint pains and muscle aches but ok today

Release 3 — day 7, dose 2

2021-02-08

Systemic reaction (other): No

Release 8 — 3 months, dose 2

2021-05-03

Symptoms: I had a complete hysterectomy. But no covid

Release 9 — 6 months, dose 2

2021-08-02

Symptoms: Full hysterectomy, Bakers cyst, need a knee replacement

Release 10 — day 7, dose 3

2021-10-24

Systemic reaction (other): I had soreness when At the site when I got the shot but not now.

Release 11 — day 28, dose 4

2022-05-16

Symptoms: Sinusitis but no fever. I am congested like a head cold.

Release 12 — 3 months, dose 4

2022-07-18

Symptoms: The other day Fri I was very father and I went to bed. I thought I had Covid. On Sunday I took the test and it was negative.

Release 12 — day 14, dose 5

2022-10-01

Symptoms: Viral gastroenteritis enteritis and urinary tract infection

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	Cerebral haemorrhage	·	·	✓
SD	Enteritis	·	·	✓
SD	Fall	·	·	✓
SD	Gastroenteritis viral	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Hospitalisation	·	·	✓
SD	Hysterectomy	✓	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Sinusitis	·	·	✓
SD	Synovial cyst	✓	·	✓
SD	Unevaluable event	·	·	✓
SD	Urinary tract infection	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Immediate post-injection reaction	·	·	✓
SRO	Injection site pain	·	·	✓
SRO	Myalgia	✓	✓	✓
SRO	No adverse event	✓	✓	✓

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