CV9-12798-42092

3 vaccinations 5 coded responses 35 check-ins 5 free-text entries 2 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 064 / CT
Registered: 2021-01-01

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

2020-12-30
Dose 1 — Moderna
2021-01-01
Registered in v-safe
2021-01-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-01-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-06
Health check-in — day 7, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-13
Health check-in — day 14, dose 1
Feeling: Good

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

Adult check-in
2021-01-27
Dose 2 — Moderna
2021-01-27
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Fever · Headache, Muscle or body aches

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache

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

Adult check-in
2021-02-03
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-02-10
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-17
Survey response — day 21, dose 2
MedDRA: Mouth ulceration, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Ulcerations in mouth · Healthcare visit (other): Awaiting appointment with physician

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-17
Report sent to call center — day 21, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-24
Survey response — day 28, dose 2
MedDRA: Mouth ulceration, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional

Free text: Symptoms: Oral ulcerations persist · Healthcare visit (other): Specialist consultation

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-24
Report sent to call center — day 28, dose 2
Get care from a doctor or other healthcare professional

1 call case(s)
2021-03-03
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-10
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-04-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-07-28
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-08-04
Call 1 — Left Voicemail
2021-11-05
Dose 3 — Pfizer-BioNTech
2021-11-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness · Fever · Chills, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-07
Survey response — days 1–6 daily, dose 3
MedDRA: Breast pain, Lymphadenopathy — Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Left axilla adenopathy and left breast pain

MedDRA releases: 2024-11 · check-in free text available
2021-11-08
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Oedema peripheral — Feeling: Good · Site: Pain

Free text: Axillary pain, swelling

MedDRA releases: 2024-11 · check-in free text available
2021-11-09
Survey response — days 1–6 daily, dose 3
MedDRA: Lymphadenopathy — Feeling: Good · Headache

Free text: Lymph node swelling- improved

MedDRA releases: 2024-11 · check-in free text available
2021-11-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache

Adult check-in
2021-11-12
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-28
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-05
Health check-in — day 28, dose 3
Feeling: Good

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

Adult check-in
2021-12-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-04
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-06
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2020-12-30	Moderna
2	2021-01-27	Moderna
3	2021-11-05	Pfizer-BioNTech	No

Call center

2 call center cases

2 unsuccessful

1 wait over 3 months for a first call

See the call center timeline

Free text

Release 4 — day 21, dose 2

2021-02-17

Symptoms: Ulcerations in mouth

Healthcare visit (other): Awaiting appointment with physician

Release 4 — day 28, dose 2

2021-02-24

Symptoms: Oral ulcerations persist

Healthcare visit (other): Specialist consultation

Release 10 — days 1–6 daily, dose 3

2021-11-07

Systemic reaction (other): Left axilla adenopathy and left breast pain

2021-11-08

Systemic reaction (other): Axillary pain, swelling

2021-11-09

Systemic reaction (other): Lymph node swelling- improved

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	Office visit	✓	✓	✓
SD	Mouth ulceration	✓	✓	✓
SRO	Axillary pain	·	·	✓
SRO	Breast pain	·	·	✓
SRO	Lymphadenopathy	·	·	✓
SRO	Oedema peripheral	·	·	✓

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