LNJ-22539-61535

4 vaccinations 6 coded responses 48 check-ins 6 free-text entries 0 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 303 / GA
Registered: 2021-03-04

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

Registered dependents

Y2Q-13458-03913 Child or adolescent in my care · Female · 2021-11-11

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-03-03
Dose 1 — Moderna
2021-03-04
Registered in v-safe
2021-03-04
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness, Diarrhea

Adult check-in
2021-03-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

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

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-03-17
Survey response — day 14, dose 1
MedDRA: Abdominal pain upper, Condition aggravated, Gastric ulcer, Pre-existing disease — Feeling: Good

Free text: Stomach aches/ hx of gastric ulcers and same pain long before vaccination

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-24
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-31
Dose 2 — Moderna
2021-03-31
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-02
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Felt the same yesterday but improved since this afternoon.

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

Adult check-in
2021-04-04
Survey response — days 1–6 daily, dose 2
MedDRA: Rash — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site

Free text: Mild rash to face started yesterday and today but seems to be disappearing. Not itchy or painful. Only to face.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-04-14
Survey response — day 14, dose 2
MedDRA: Headache — Feeling: Good

Free text: Headache. Mild but constant the past few days.

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

Adult check-in
2021-04-29
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-12
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-30
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-30
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-10
Dose 3 — Moderna
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: Abdominal discomfort — Feeling: Good · Site: Pain · Diarrhea

Free text: Mild upset stomach

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Survey response — days 1–6 daily, dose 3
MedDRA: Back pain — Feeling: Good · Site: Pain · Headache

Free text: Mild back pain

MedDRA releases: 2024-11 · check-in free text available
2021-11-14
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-16
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-20
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-11-26
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-01
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-08
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-12-22
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-09
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-12
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-08
Dose 4 — Moderna
2022-11-08
Health check-in — day 0, dose 4
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2022-11-09
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-11-12
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-13
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-11-15
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-11-22
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-30
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-12-06
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-12-15
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-22
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-02-07
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-05-15
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-03	Moderna
2	2021-03-31	Moderna
3	2021-11-10	Moderna	No
4	2022-11-08	Moderna	No

Free text

Release 5 — day 14, dose 1

2021-03-17

Symptoms: Stomach aches/ hx of gastric ulcers and same pain long before vaccination

Release 6 — days 1–6 daily, dose 2

2021-04-02

Systemic reaction (other): Felt the same yesterday but improved since this afternoon.

2021-04-04

Systemic reaction (other): Mild rash to face started yesterday and today but seems to be disappearing. Not itchy or painful. Only to face.

Release 7 — day 14, dose 2

2021-04-14

Symptoms: Headache. Mild but constant the past few days.

Release 10 — days 1–6 daily, dose 3

2021-11-11

Systemic reaction (other): Mild upset stomach

2021-11-12

Systemic reaction (other): Mild back pain

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 pain upper	✓	✓	✓
SD	Condition aggravated	✓	✓	✓
SD	Gastric ulcer	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SRO	Abdominal discomfort	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Back pain	·	·	✓
SRO	Rash	✓	✓	✓

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