6YB-61979-91461

4 vaccinations 20 coded responses 49 check-ins 20 free-text entries 4 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 920 / CA
Registered: 2021-02-06

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

2021-02-06
Registered in v-safe
2021-02-06
Dose 1 — Moderna
2021-02-07
Survey response — days 1–6 daily, dose 1
MedDRA: Abdominal discomfort, Decreased appetite — Feeling: Good · Site: Pain

Free text: Upset stomach, loss of appetite

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Diarrhea

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-20
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-03-13
Health check-in — day 35, dose 1
Feeling: Good

Adult check-in
2021-03-16
Dose 2 — Moderna
2021-03-20
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia — Feeling: Fair · Site: Pain

Free text: Fever of 100 day after.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-21
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-23
Survey response — day 7, dose 2
MedDRA: Pyrexia — Feeling: Good

Free text: I had a fever of 101 on second day after shot.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Survey response — day 14, dose 2
MedDRA: Gastrooesophageal reflux disease, Urinary retention — Feeling: Fair

Free text: Increased acid refluxUrinary retention

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-13
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-20
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-27
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-15
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-15
Survey response — 6 months, dose 2
MedDRA: Abdominal discomfort, Diarrhoea, Pain, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Gastrointestinal discomfort, loose stools, low grade fever, aches and pains.

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Dose 3 — Moderna
2021-11-22
Health check-in — day 0, dose 3
Feeling: Good · Fatigue or tiredness

Free text: Hiccups

Adult check-in · check-in free text available
2021-11-23
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Dry throat, Middle insomnia, Muscle spasms — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Extremely dry throat waking me up with coughing spams.

MedDRA releases: 2024-11 · check-in free text available
2021-11-24
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Survey response — day 7, dose 3
MedDRA: No adverse event — Feeling: Good

Free text: No

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-27
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-21
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-13
Dose 4 — Moderna
2022-05-15
Survey response — days 1–6 daily, dose 4
MedDRA: Gastrointestinal disorder — Feeling: Poor · Site: Pain · Muscle or body aches, Nausea · Be unable to do your normal daily activities

Free text: Gastro-intestinal issues.

MedDRA releases: 2024-11 · check-in free text available
2022-05-16
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness, Diarrhea, Abdominal pain

Adult check-in
2022-05-17
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness, Abdominal pain

Adult check-in
2022-05-19
Survey response — days 1–6 daily, dose 4
MedDRA: No adverse event — Feeling: Good · Fatigue or tiredness

Free text: None

MedDRA releases: 2024-11 · check-in free text available
2022-05-20
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-10
Survey response — day 28, dose 4
MedDRA: Gastrointestinal disorder, Gastrointestinal pain — Feeling: Good

Free text: Gastrointestinal disturbances and pain

MedDRA releases: 2024-11 · check-in free text available
2022-06-17
Survey response — day 35, dose 4
MedDRA: Gastrointestinal disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Gastrointestinal disturbances

MedDRA releases: 2024-11 · check-in free text available
2022-06-17
Report sent to call center — day 35, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-06-21
Call 1 — Left Voicemail
2022-06-24
Survey response — day 42, dose 4
MedDRA: Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: UTI

MedDRA releases: 2024-11 · check-in free text available
2022-06-24
Report sent to call center — day 42, dose 4
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-06-27
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-08-12
Survey response — 3 months, dose 4
MedDRA: Diarrhoea, Rash, SARS-CoV-2 test positive, Urticaria — 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

Free text: Tested positive for Covid around 7/13 to 7/18/22. 7/24/22 started a body rash with la he hives I originally thought were bug bites. On 8/9/22 I started having profuse diarrhea and still having it.

MedDRA releases: 2024-11 · check-in free text available
2022-08-12
Report sent to call center — 3 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)
2022-08-15
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-11
Survey response — 6 months, dose 4
MedDRA: Abdominal pain, Cholelithiasis — Feeling: Good

Free text: Abdominal pain. I'm being evaluated for gall bladder issues due to stones.

MedDRA releases: 2024-11 · check-in free text available
2023-05-13
Survey response — 12 months, dose 4
MedDRA: Aneurysm, Deep vein thrombosis, Hiatus hernia, Pulmonary embolism — 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, Emergency room or emergency department visit, Hospitalization

MedDRA releases: 2024-11
2023-05-13
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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2023-05-15
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-06	Moderna
2	2021-03-16	Moderna
3	2021-11-22	Moderna	No
4	2022-05-13	Moderna	No

Call center

4 call center cases

3 successful · 1 unsuccessful

See the call center timeline

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-07

Systemic reaction (other): Upset stomach, loss of appetite

Release 6 — days 1–6 daily, dose 2

2021-03-20

Systemic reaction (other): Fever of 100 day after.

Release 6 — day 7, dose 2

2021-03-23

Systemic reaction (other): I had a fever of 101 on second day after shot.

Release 6 — day 14, dose 2

2021-03-30

Symptoms: Increased acid refluxUrinary retention

Release 9 — 6 months, dose 2

2021-09-15

Symptoms: Gastrointestinal discomfort, loose stools, low grade fever, aches and pains.

Release 10 — days 1–6 daily, dose 3

2021-11-23

Systemic reaction (other): Extremely dry throat waking me up with coughing spams.

2021-11-24

Systemic reaction (other): No

2021-11-25

Systemic reaction (other): None

2021-11-26

Systemic reaction (other): No

2021-11-27

Systemic reaction (other): No

2021-11-28

Systemic reaction (other): No

Release 10 — day 7, dose 3

2021-11-29

Systemic reaction (other): No

Release 11 — days 1–6 daily, dose 4

2022-05-15

Systemic reaction (other): Gastro-intestinal issues.

2022-05-19

Systemic reaction (other): None

Release 12 — day 0, dose 3

2021-11-22

Systemic reaction (other): Hiccups

Release 12 — day 28, dose 4

2022-06-10

Symptoms: Gastrointestinal disturbances and pain

Release 12 — day 35, dose 4

2022-06-17

Symptoms: Gastrointestinal disturbances

Release 12 — day 42, dose 4

2022-06-24

Symptoms: UTI

Release 12 — 3 months, dose 4

2022-08-12

Symptoms: Tested positive for Covid around 7/13 to 7/18/22. 7/24/22 started a body rash with la he hives I originally thought were bug bites. On 8/9/22 I started having profuse diarrhea and still having it.

Release 12 — 6 months, dose 4

2022-11-11

Symptoms: Abdominal pain. I'm being evaluated for gall bladder issues due to stones.

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	·	·	✓
SD	Aneurysm	·	·	✓
SD	Cholelithiasis	·	·	✓
SD	Deep vein thrombosis	·	·	✓
SD	Diarrhoea	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Gastrointestinal pain	·	·	✓
SD	Gastrooesophageal reflux disease	✓	✓	✓
SD	Hiatus hernia	·	·	✓
SD	Pain	·	·	✓
SD	Pulmonary embolism	·	·	✓
SD	Pyrexia	·	·	✓
SD	Rash	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Urinary retention	✓	✓	✓
SD	Urinary tract infection	·	·	✓
SD	Urticaria	·	·	✓
SRO	Abdominal discomfort	✓	✓	✓
SRO	Cough	·	·	✓
SRO	Decreased appetite	✓	✓	✓
SRO	Dry throat	·	·	✓
SRO	Gastrointestinal disorder	·	·	✓
SRO	Middle insomnia	·	·	✓
SRO	Muscle spasms	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Pyrexia	✓	✓	✓

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