A3H-15485-19415

4 vaccinations 8 coded responses 37 check-ins 8 free-text entries 2 call cases

Sex: Female
Age at first dose: 31-35
ZIP prefix: 452 / OH
Registered: 2021-01-19

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

Registered dependents

X63-11038-83775 Child or adolescent in my care · Female · 2022-06-30

Timeline

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

2021-01-19
Registered in v-safe
2021-01-19
Dose 1 — Moderna
2021-01-19
Health check-in — day 0, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-22
Survey response — days 1–6 daily, dose 1
MedDRA: Hospitalisation, Hypertension, Postpartum state — Feeling: Fair

Free text: I am 9 days post partum and have had high blood pressure requiring hospital admission. This is likely due to my pregnancy

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-23
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Diarrhea

Adult check-in
2021-01-24
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-25
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-26
Health check-in — day 7, dose 1
Feeling: Good · None

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

Adult check-in
2021-02-09
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-16
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-19
Dose 2 — Moderna
2021-02-19
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-20
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Feeling hot, Hyperhidrosis — Feeling: Fair · Site: Pain · Headache

Free text: Hot sweats

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Diabetes mellitus, Pre-existing disease — Feeling: Fair · Site: Pain · Headache

Free text: I forgot to report this the previous 2 days- hyperglycemia ( i have type 1 diabetes), blood sugars over 200 despite increasing basal by 150% for the past 3 days

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-26
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-05
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-12
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-19
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-26
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-02
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-20
Survey response — 6 months, dose 2
MedDRA: Cough, Headache, Nasopharyngitis, Respiratory tract congestion, Rhinorrhoea — Feeling: Good · Be unable to work or attend school

Free text: Cold symptoms - cough, congestion, nasal drainage, headache

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-09-15
Dose 3 — Moderna
Co-administered: Flu
2021-10-27
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2021-12-15
Survey response — 3 months, dose 3
MedDRA: Cough, Malaise, Migraine, Pyrexia, Respiratory tract congestion, Unevaluable event — 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 · Outpatient clinic or urgent care clinic visit

Free text: Symptoms: Covid related symptoms -malaise, migraine, congestion, fever, cough · Healthcare visit (other): Anticovid antibody treatment from an infusion center

MedDRA releases: 2024-11 · check-in free text available
2021-12-15
Report sent to call center — 3 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2021-12-16
Call 1 — Left Voicemail
2022-03-16
Survey response — 6 months, dose 3
MedDRA: Depression — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit

Free text: Depression

MedDRA releases: 2024-11 · check-in free text available
2022-03-16
Report sent to call center — 6 months, dose 3
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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-03-17
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-09-17
Dose 4 — Moderna
2022-09-17
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in
2022-09-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-09-24
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-10-01
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-08
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-15
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-10-22
Survey response — day 35, dose 4
MedDRA: Gastrointestinal disorder, Respiratory symptom — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Suspected adenovirus - GI symptoms and upper respiratory symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-10-29
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-12-17
Survey response — 3 months, dose 4
MedDRA: Upper respiratory tract infection — Feeling: Good · Be unable to work or attend school

Free text: Multiple upper respiratory infections (standard child)

MedDRA releases: 2024-11 · check-in free text available
2023-03-18
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-19	Moderna
2	2021-02-19	Moderna
3	2021-09-15	Moderna	Flu
4	2022-09-17	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-22

Systemic reaction (other): I am 9 days post partum and have had high blood pressure requiring hospital admission. This is likely due to my pregnancy

Release 4 — days 1–6 daily, dose 2

2021-02-21

Systemic reaction (other): Hot sweats

2021-02-22

Systemic reaction (other): I forgot to report this the previous 2 days- hyperglycemia ( i have type 1 diabetes), blood sugars over 200 despite increasing basal by 150% for the past 3 days

Release 9 — 6 months, dose 2

2021-08-20

Symptoms: Cold symptoms - cough, congestion, nasal drainage, headache

Release 10 — 3 months, dose 3

2021-12-15

Symptoms: Covid related symptoms -malaise, migraine, congestion, fever, cough

Healthcare visit (other): Anticovid antibody treatment from an infusion center

Release 11 — 6 months, dose 3

2022-03-16

Symptoms: Depression

Release 12 — day 35, dose 4

2022-10-22

Symptoms: Suspected adenovirus - GI symptoms and upper respiratory symptoms

Release 12 — 3 months, dose 4

2022-12-17

Symptoms: Multiple upper respiratory infections (standard child)

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	Unevaluable event	·	·	✓
SD	Cough	✓	·	✓
SD	Depression	·	·	✓
SD	Gastrointestinal disorder	·	·	✓
SD	Headache	✓	·	✓
SD	Malaise	·	·	✓
SD	Migraine	·	·	✓
SD	Nasopharyngitis	✓	·	✓
SD	Pyrexia	·	·	✓
SD	Respiratory symptom	·	·	✓
SD	Respiratory tract congestion	✓	·	✓
SD	Rhinorrhoea	✓	·	✓
SD	Upper respiratory tract infection	·	·	✓
SRO	Diabetes mellitus	✓	✓	✓
SRO	Feeling hot	✓	✓	✓
SRO	Hospitalisation	✓	✓	✓
SRO	Hyperhidrosis	✓	✓	✓
SRO	Hypertension	✓	✓	✓
SRO	Postpartum state	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓

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