9UD-24699-32634

4 vaccinations 6 coded responses 23 check-ins 6 free-text entries 5 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 600 / IL
Registered: 2021-03-20

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

2021-03-19
Dose 1 — Moderna
2021-03-20
Registered in v-safe
2021-03-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Itching · Headache

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

Adult check-in
2021-03-24
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-04-16
Dose 2 — Moderna
2021-04-16
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Headache

Adult check-in
2021-07-16
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-15
Survey response — 6 months, dose 2
MedDRA: Pregnancy — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Pregnancy

MedDRA releases: 2024-11 · check-in free text available
2021-10-15
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-10-22
Call 1 — Could Not Reach Participant
2021-10-27
Call 2 — Could Not Reach Participant
2021-11-04
Dose 3 — Moderna
2021-11-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-11-07
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-08
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-11
Health check-in — day 7, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-18
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-25
Survey response — day 21, dose 3
MedDRA: Headache — Feeling: Good · 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: Severe headache

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Report sent to call center — day 21, dose 3
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)
2021-12-04
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-16
Survey response — day 42, dose 3
MedDRA: Sensation of foreign body — Feeling: Fair

Free text: Lump in the throat feeling

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Call 1 — Could Not Reach Participant
2022-01-18
Call 2 — Could Not Reach Participant
2022-02-03
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-05
Survey response — 6 months, dose 3
MedDRA: Breast feeding, Delivery — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Gave birth and breastfeeding · Healthcare visit (other): Home birth

MedDRA releases: 2024-11 · check-in free text available
2022-05-05
Report sent to call center — 6 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-05-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-06
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-09-08
Dose 4 — Moderna
2022-11-06
Survey response — 12 months, dose 3
MedDRA: Metamorphopsia — Feeling: Good · 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: Distortion of vision

MedDRA releases: 2024-11 · check-in free text available
2022-11-06
Report sent to call center — 12 months, dose 3
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)
2022-11-07
Call successful
Not applicable - Accidental Reporting
2022-12-08
Survey response — 3 months, dose 4
MedDRA: Eye haemorrhage — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Had a blood vessel break in my retina

MedDRA releases: 2024-11 · check-in free text available
2022-12-08
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-12-09
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-19	Moderna
2	2021-04-16	Moderna
3	2021-11-04	Moderna	No
4	2022-09-08	Moderna	No

Call center

5 call center cases

4 successful · 1 unsuccessful

See the call center timeline

Free text

Release 10 — 6 months, dose 2

2021-10-15

Symptoms: Pregnancy

Release 10 — day 21, dose 3

2021-11-25

Symptoms: Severe headache

Release 10 — day 42, dose 3

2021-12-16

Symptoms: Lump in the throat feeling

Release 11 — 6 months, dose 3

2022-05-05

Symptoms: Gave birth and breastfeeding

Healthcare visit (other): Home birth

Release 12 — 12 months, dose 3

2022-11-06

Symptoms: Distortion of vision

Release 12 — 3 months, dose 4

2022-12-08

Symptoms: Had a blood vessel break in my retina

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
HCVO	Delivery	·	·	✓
SD	Breast feeding	·	·	✓
SD	Delivery	·	·	✓
SD	Eye haemorrhage	·	·	✓
SD	Headache	·	·	✓
SD	Metamorphopsia	·	·	✓
SD	Pregnancy	·	·	✓
SD	Sensation of foreign body	·	·	✓

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