6UW-32902-04438

4 vaccinations 15 coded responses 23 check-ins 14 free-text entries 5 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 105 / NY
Registered: 2021-01-07

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

Timeline

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

2021-01-05
Dose 1 — Moderna
2021-01-07
Registered in v-safe
2021-01-07
Survey response — days 1–6 daily, dose 1
MedDRA: Sleep disorder — Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Disturbed sleep, increase in stomach acid

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-08
Survey response — days 1–6 daily, dose 1
MedDRA: Cough, Sleep disorder — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Disturbed sleep because of cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Fair · Site: Itching

Free text: Itching on and off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good

Free text: Occasional itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-26
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-01-31
Dose 2 — Moderna
2021-02-02
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Chills, Dizziness, Pain — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: First 2 days lots of chills and aches, dizziness and off balance when up and about

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-03
Survey response — days 1–6 daily, dose 2
MedDRA: Balance disorder, Dizziness — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Dizziness, out of balance when moving, standing up

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-04
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Ear inflammation, Neck pain — Feeling: Fair · Joint pains · Be unable to work, Be unable to do your normal daily activities

Free text: Neck pain, ear inflammation, dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness, Ear pain — Feeling: Good · Joint pains

Free text: Little dizzy, off balance. ear ache and pressure

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-14
Health check-in — day 14, dose 2
Feeling: Good

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

Adult check-in
2021-03-16
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-04
Survey response — 3 months, dose 2
MedDRA: Abdominal pain upper, Dyspepsia, Eructation, Flatulence, Irritable bowel syndrome, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: IBS worsened. Stomach ache, gas, belching , indigestion increased. Does not respond to provide ac, protonix. Apt with doctor scheduled after a week.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-01
Dose 3 — Moderna
2022-02-04
Survey response — 12 months, dose 2
MedDRA: Asthma, Bronchitis, Eye infection, Gastric ulcer, Inflammation, Nasopharyngitis, Unevaluable event — Feeling: Poor · 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

Free text: Stomach ulcers , inflammation since June 2021. , cold, sinus, asthma, bronchitis, Jan 2022, eye infection 3-4 months ago,

MedDRA releases: 2024-11 · check-in free text available
2022-02-04
Report sent to call center — 12 months, dose 2
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)
2022-02-11
Call 1 — Left Voicemail
2022-04-02
Dose 4 — Moderna
2022-04-27
Survey response — day 21, dose 4
MedDRA: Gastrooesophageal reflux disease, Sciatica — Feeling: Fair · 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: Sciatica pain, acid reflux.

MedDRA releases: 2024-11 · check-in free text available
2022-04-27
Report sent to call center — day 21, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-04-28
Call 2 — Left Voicemail
2022-05-01
Health check-in — day 28, dose 4
Feeling: Fair

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

Adult check-in
2022-05-14
Survey response — day 42, dose 4
MedDRA: Condition aggravated, Gastritis, Gastrooesophageal reflux disease, Hepatic enzyme increased, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Flare up of stomach ulcers, inflammation of gastric passage,acid reflux developed year ago. Elevated liver enzyme than year ago.

MedDRA releases: 2024-11 · check-in free text available
2022-05-14
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-05-17
Call 2 — Left Voicemail
2022-07-02
Survey response — 3 months, dose 4
MedDRA: COVID-19 — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: COVID infection. Needed to take plaxovid. Recovery after 10 days

MedDRA releases: 2024-11 · check-in free text available
2022-07-02
Report sent to call center — 3 months, dose 4
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-05
Call 3 — Left Voicemail
2022-07-05
Call 3 — Left Voicemail
2022-07-05
Call 3 — Left Voicemail
2022-07-05
Call 2 — Left Voicemail
2022-10-01
Survey response — 6 months, dose 4
MedDRA: Abdominal discomfort, Abdominal pain upper, COVID-19, Cough, Flatulence, Gastrointestinal disorder, Gastrooesophageal reflux disease, Headache, Nasopharyngitis, Respiratory tract congestion, Sinusitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Sept 12th, another Covid episode , cold, congestion , head aches, cough etc . Lasted for a week. Covid - ve home test after / weeks. 10 days later, stomach issues. Upset stomach, severe acid reflux, stomach ache Gas etc. , sinusitus,

MedDRA releases: 2024-11 · check-in free text available
2023-04-03
Survey response — 12 months, dose 4
MedDRA: Gastrointestinal disorder, Gastrooesophageal reflux disease, Haemorrhoids — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-04-03
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

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-04
Call 2 — Left Voicemail
2023-04-04
Call 1 — Left Voicemail
2023-04-04
Call 1 — Left Voicemail
2023-04-04
Call 1 — Left Voicemail
2023-04-04
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-05	Moderna
2	2021-01-31	Moderna
3	2021-09-01	Moderna	No
4	2022-04-02	Moderna	No

Call center

5 call center cases

5 unsuccessful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-07

Systemic reaction (other): Disturbed sleep, increase in stomach acid

2021-01-08

Systemic reaction (other): Disturbed sleep because of cough.

2021-01-09

Systemic reaction (other): Itching on and off

2021-01-11

Systemic reaction (other): Occasional itching

Release 3 — days 1–6 daily, dose 2

2021-02-02

Systemic reaction (other): First 2 days lots of chills and aches, dizziness and off balance when up and about

2021-02-03

Systemic reaction (other): Dizziness, out of balance when moving, standing up

2021-02-04

Systemic reaction (other): Neck pain, ear inflammation, dizziness

2021-02-05

Systemic reaction (other): Little dizzy, off balance. ear ache and pressure

Release 8 — 3 months, dose 2

2021-05-04

Symptoms: IBS worsened. Stomach ache, gas, belching , indigestion increased. Does not respond to provide ac, protonix. Apt with doctor scheduled after a week.

Release 11 — 12 months, dose 2

2022-02-04

Symptoms: Stomach ulcers , inflammation since June 2021. , cold, sinus, asthma, bronchitis, Jan 2022, eye infection 3-4 months ago,

Release 11 — day 21, dose 4

2022-04-27

Symptoms: Sciatica pain, acid reflux.

Release 11 — day 42, dose 4

2022-05-14

Symptoms: Flare up of stomach ulcers, inflammation of gastric passage,acid reflux developed year ago. Elevated liver enzyme than year ago.

Release 12 — 3 months, dose 4

2022-07-02

Symptoms: COVID infection. Needed to take plaxovid. Recovery after 10 days

Release 12 — 6 months, dose 4

2022-10-01

Symptoms: Sept 12th, another Covid episode , cold, congestion , head aches, cough etc . Lasted for a week. Covid - ve home test after / weeks. 10 days later, stomach issues. Upset stomach, severe acid reflux, stomach ache Gas etc. , sinusitus,

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 discomfort	·	·	✓
SD	Abdominal pain upper	✓	✓	✓
SD	Asthma	·	·	✓
SD	Bronchitis	·	·	✓
SD	Condition aggravated	·	·	✓
SD	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Dyspepsia	✓	✓	✓
SD	Eructation	✓	✓	✓
SD	Eye infection	·	·	✓
SD	Flatulence	✓	✓	✓
SD	Gastric ulcer	·	·	✓
SD	Gastritis	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Gastrooesophageal reflux disease	·	·	✓
SD	Haemorrhoids	·	·	✓
SD	Headache	·	·	✓
SD	Hepatic enzyme increased	·	·	✓
SD	Inflammation	·	·	✓
SD	Irritable bowel syndrome	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Sciatica	·	·	✓
SD	Sinusitis	·	·	✓
SD	Unevaluable event	·	·	✓
SRO	Balance disorder	✓	✓	✓
SRO	Chills	✓	✓	✓
SRO	Cough	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Ear inflammation	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Gastric pH decreased	○	○	○
SRO	Neck pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Sleep disorder	✓	✓	✓

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