K84-12442-29530

4 vaccinations 6 coded responses 53 check-ins 4 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 453 / OH
Registered: 2021-07-28

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

Registered dependents

9V6-22619-64979 Child or adolescent in my care · Female · 2022-07-09

Timeline

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

2021-07-28
Registered in v-safe
2021-07-28
Dose 1 — Moderna
2021-07-28
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-07-30
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site reaction — Feeling: Fair · Muscle or body aches

Free text: in right arm, injection site

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-07-31
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-08-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-03
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-08-04
Health check-in — day 7, dose 1
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-08-11
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-08-18
Survey response — day 21, dose 1
MedDRA: Pregnancy, Rash — Feeling: Good

Free text: have rash on leg, no where near injection site on upper right thigh under buttocks. consulting doc to determine cause or if due to pregnancy.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-25
Survey response — day 28, dose 1
MedDRA: Herpes zoster — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Diagnosed with shingles on 8-19-2021. Complication from first shot. Scheduled for 2nd shot on Sep 1, 2021.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-08-25
Report sent to call center — day 28, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-08-27
Call 1 — Left Voicemail
2021-09-01
Dose 2 — Moderna
2021-09-01
Health check-in — day 0, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Redness, Swelling · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-09-05
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Adult check-in
2021-09-06
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-09-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-08
Health check-in — day 7, dose 2
Feeling: Fair · Site: Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-09-15
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-09-22
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-09-29
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-10-06
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-10-13
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-12-01
Survey response — 3 months, dose 2
MedDRA: Oedema, Pre-eclampsia, Pregnancy — 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 · Emergency room or emergency department visit, Hospitalization

Free text: Preeclampsia, 37week. Major edema.

MedDRA releases: 2024-11 · check-in free text available
2021-12-01
Report sent to call center — 3 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Emergency room or emergency department visit · Hospitalization · 1 call case(s)
2021-12-02
Call 1 — Left Voicemail
2021-12-02
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-03-02
Dose 3 — Moderna
2022-03-02
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-02
Health check-in — day 0, dose 3
Feeling: Good · None

Adult check-in
2022-03-03
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness · Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2022-03-04
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2022-03-05
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-03-06
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-03-07
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-03-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-03-09
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2022-03-16
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2022-03-23
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2022-03-30
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2022-04-06
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2022-04-13
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-06-01
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-08-31
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2023-01-27
Dose 4 — Moderna
2023-01-28
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2023-01-29
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2023-01-30
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fatigue or tiredness

Adult check-in
2023-01-31
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2023-02-01
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2023-02-02
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2023-02-03
Health check-in — day 7, dose 4
Feeling: Fair · Fatigue or tiredness

Adult check-in
2023-02-11
Survey response — day 14, dose 4
MedDRA: Pregnancy — Feeling: Fair

MedDRA releases: 2024-11
2023-02-17
Health check-in — day 21, dose 4
Feeling: Fair

Adult check-in
2023-02-24
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2023-03-03
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2023-03-10
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-04-28
Survey response — 3 months, dose 4
MedDRA: Sinusitis — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-07-28	Moderna	No
2	2021-09-01	Moderna	No
3	2022-03-02	Moderna	No
4	2023-01-27	Moderna	No

Call center

2 call center cases

1 successful · 1 unsuccessful

See the call center timeline

Free text

Release 9 — days 1–6 daily, dose 1

2021-07-30

Systemic reaction (other): in right arm, injection site

Release 9 — day 21, dose 1

2021-08-18

Symptoms: have rash on leg, no where near injection site on upper right thigh under buttocks. consulting doc to determine cause or if due to pregnancy.

Release 9 — day 28, dose 1

2021-08-25

Symptoms: Diagnosed with shingles on 8-19-2021. Complication from first shot. Scheduled for 2nd shot on Sep 1, 2021.

Release 10 — 3 months, dose 2

2021-12-01

Symptoms: Preeclampsia, 37week. Major edema.

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	Herpes zoster	✓	·	✓
SD	Oedema	·	·	✓
SD	Pre-eclampsia	·	·	✓
SD	Pregnancy	✓	·	✓
SD	Rash	✓	·	✓
SD	Sinusitis	·	·	✓
SRO	Injection site reaction	✓	·	✓

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