M7U-27856-06316

5 vaccinations 17 coded responses 27 check-ins 14 free-text entries 3 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 287 / NC
Registered: 2021-11-24

Relationship: Adult relative or friend
Guardian: 6LT-25417-59032
Race: Asian
Ethnicity: Not Hispanic or Latino

Timeline

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

2021-01-21
Dose 1 — Moderna
2021-02-20
Dose 2 — Moderna
2021-11-22
Dose 3 — Moderna
2021-11-24
Registered in v-safe
2021-11-24
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Deafness — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Deafness

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Ear pain, Eye pain, Hearing aid user, Hypoacusis, Lacrimal disorder, Lacrimation increased — Feeling: Fair · Site: Pain, Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Ear aches, orbital pain, tearing, hard of hearing even with fresh battery for hearing aids

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Balance disorder, Ear congestion, Eye irritation, Hypoacusis, Walking aid user — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Burning eyes, stuffy ears, hard of hearing, balancing problem, use of walker

MedDRA releases: 2024-11 · check-in free text available
2021-11-27
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Arthralgia, Back pain, Cough, Dyspnoea, Eye pain, Hypoacusis, Malaise, Neck pain, Spinal pain — Feeling: Fair · Site: Redness · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Hard of hearing, general malaise, spinal column pain, shoulder,neck, back pain. Short of breath, dry cough, orbital pain to touch.

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Survey response — days 1–6 daily, dose 3, dependent
MedDRA: Brain fog, Fatigue, Malaise, Musculoskeletal stiffness, Spinal pain — Feeling: Fair · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Brain fog, malaise, back spine column pain, stiffness, fatigue

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Survey response — day 7, dose 3, dependent
MedDRA: Apathy, Asthenia, Decreased interest, Eye pain, Malaise — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Apathy, orbital pain to touch, lack of interest and energy, general malaise

MedDRA releases: 2024-11 · check-in free text available
2021-12-06
Health check-in — day 14, dose 3, dependent
Feeling: Good

Adult check-in
2021-12-13
Health check-in — day 21, dose 3, dependent
Feeling: Good

Adult check-in
2021-12-20
Health check-in — day 28, dose 3, dependent
Feeling: Good

Adult check-in
2021-12-27
Health check-in — day 35, dose 3, dependent
Feeling: Good

Adult check-in
2022-01-05
Health check-in — day 42, dose 3, dependent
Feeling: Good

Adult check-in
2022-02-21
Survey response — 3 months, dose 3, dependent
MedDRA: Abdominal pain upper, Gastric ulcer, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Gastric ulcer and treatment for 15 days on Prilosec. Still right upper quadrant soreness . Waiting for upper and lower endoscopy · Healthcare visit (other): At work in the hospital by a Gastro surgeon

MedDRA releases: 2024-11 · check-in free text available
2022-02-21
Report sent to call center — 3 months, dose 3, dependent
Get care from a doctor or other healthcare professional

1 call case(s)
2022-02-24
Call 1 — Left Voicemail
2022-05-20
Dose 4 — Moderna
2022-05-23
Health check-in — 6 months, dose 3, dependent
Feeling: Fair

Adult check-in
2022-11-30
Dose 5 — Moderna
Co-administered: Flu
2022-12-01
Survey response — days 1–6 daily, dose 5, dependent
MedDRA: Decreased appetite — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Loss of appetite

MedDRA releases: 2024-11 · check-in free text available
2022-12-02
Survey response — days 1–6 daily, dose 5, dependent
MedDRA: Apathy, Brain fog — Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Apathy, Foggy.

MedDRA releases: 2024-11 · check-in free text available
2022-12-03
Survey response — days 1–6 daily, dose 5, dependent
MedDRA: Confusional state, Decreased gait velocity, Headache, Spinal pain — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Slow gait, spine pain, confusion, temporal pain

MedDRA releases: 2024-11 · check-in free text available
2022-12-04
Health check-in — days 1–6 daily, dose 5, dependent
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-12-05
Survey response — days 1–6 daily, dose 5, dependent
MedDRA: Anxiety, Neck pain, Periorbital pain — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Peri orbital pain, neck pain. Uneasy feeling

MedDRA releases: 2024-11 · check-in free text available
2022-12-06
Survey response — days 1–6 daily, dose 5, dependent
MedDRA: Bone pain, Headache, Neck pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school

Free text: Temporal headaches, severe neck pain, bone pain

MedDRA releases: 2024-11 · check-in free text available
2022-12-07
Survey response — day 7, dose 5, dependent
MedDRA: Arthralgia, Back pain, Ear pain, Neck pain — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to work or attend school

Free text: Neck, ear aches, back, hip pains

MedDRA releases: 2024-11 · check-in free text available
2022-12-14
Health check-in — day 14, dose 5, dependent
Feeling: Fair

Adult check-in
2022-12-21
Survey response — day 21, dose 5, dependent
MedDRA: Fatigue, Office visit, Pain, Palpitations — Feeling: Fair · 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: Body aches and heart palpitations, tiredness. · Healthcare visit (other): Physicians appointment

MedDRA releases: 2024-11 · check-in free text available
2022-12-21
Report sent to call center — day 21, dose 5, dependent
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)
2022-12-22
Call 3 — Left Voicemail
2022-12-22
Call 2 — Left Voicemail
2022-12-28
Health check-in — day 28, dose 5, dependent
Feeling: Fair

Adult check-in
2023-01-04
Survey response — day 35, dose 5, dependent
MedDRA: Confusional state, Decreased appetite, Fatigue — Feeling: Fair · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-01-11
Health check-in — day 42, dose 5, dependent
Feeling: Good

Adult check-in
2023-03-01
Survey response — 3 months, dose 5, dependent
MedDRA: Asthenia, Brain fog, Memory impairment — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-06-02
Survey response — 6 months, dose 5, dependent
MedDRA: Dementia, Hypoacusis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-06-02
Call case (no matching report) — Unsuccessful
2023-06-05
Call 2 — Left Voicemail
2023-06-05
Call 1 — Left Voicemail
2023-06-05
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-21	Moderna	No
2	2021-02-20	Moderna	No
3	2021-11-22	Moderna	No
4	2022-05-20	Moderna	No
5	2022-11-30	Moderna	Flu

Call center

3 call center cases

3 unsuccessful

See the call center timeline

Free text

Release 10 — days 1–6 daily, dose 3, dependent

2021-11-24

Systemic reaction (other): Deafness

2021-11-25

Systemic reaction (other): Ear aches, orbital pain, tearing, hard of hearing even with fresh battery for hearing aids

2021-11-26

Systemic reaction (other): Burning eyes, stuffy ears, hard of hearing, balancing problem, use of walker

2021-11-27

Systemic reaction (other): Hard of hearing, general malaise, spinal column pain, shoulder,neck, back pain. Short of breath, dry cough, orbital pain to touch.

2021-11-28

Systemic reaction (other): Brain fog, malaise, back spine column pain, stiffness, fatigue

Release 10 — day 7, dose 3, dependent

2021-11-29

Systemic reaction (other): Apathy, orbital pain to touch, lack of interest and energy, general malaise

Release 11 — 3 months, dose 3, dependent

2022-02-21

Symptoms: Gastric ulcer and treatment for 15 days on Prilosec. Still right upper quadrant soreness . Waiting for upper and lower endoscopy

Healthcare visit (other): At work in the hospital by a Gastro surgeon

Release 12 — days 1–6 daily, dose 5, dependent

2022-12-01

Systemic reaction (other): Loss of appetite

2022-12-02

Systemic reaction (other): Apathy, Foggy.

2022-12-03

Systemic reaction (other): Slow gait, spine pain, confusion, temporal pain

2022-12-05

Systemic reaction (other): Peri orbital pain, neck pain. Uneasy feeling

2022-12-06

Systemic reaction (other): Temporal headaches, severe neck pain, bone pain

Release 12 — day 7, dose 5, dependent

2022-12-07

Systemic reaction (other): Neck, ear aches, back, hip pains

Release 12 — day 21, dose 5, dependent

2022-12-21

Symptoms: Body aches and heart palpitations, tiredness.

Healthcare visit (other): Physicians appointment

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	Abdominal pain upper	·	·	✓
SD	Asthenia	·	·	✓
SD	Brain fog	·	·	✓
SD	Confusional state	·	·	✓
SD	Decreased appetite	·	·	✓
SD	Dementia	·	·	✓
SD	Fatigue	·	·	✓
SD	Gastric ulcer	·	·	✓
SD	Hypoacusis	·	·	✓
SD	Memory impairment	·	·	✓
SD	Pain	·	·	✓
SD	Palpitations	·	·	✓
SRO	Anxiety	·	·	✓
SRO	Apathy	·	·	✓
SRO	Arthralgia	·	·	✓
SRO	Asthenia	·	·	✓
SRO	Back pain	·	·	✓
SRO	Balance disorder	·	·	✓
SRO	Bone pain	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Confusional state	·	·	✓
SRO	Cough	·	·	✓
SRO	Deafness	·	·	✓
SRO	Decreased appetite	·	·	✓
SRO	Decreased gait velocity	·	·	✓
SRO	Decreased interest	·	·	✓
SRO	Dyspnoea	·	·	✓
SRO	Ear congestion	·	·	✓
SRO	Ear pain	·	·	✓
SRO	Eye irritation	·	·	✓
SRO	Eye pain	·	·	✓
SRO	Fatigue	·	·	✓
SRO	Headache	·	·	✓
SRO	Hearing aid user	·	·	✓
SRO	Hypoacusis	·	·	✓
SRO	Lacrimal disorder	·	·	✓
SRO	Lacrimation increased	·	·	✓
SRO	Malaise	·	·	✓
SRO	Musculoskeletal stiffness	·	·	✓
SRO	Neck pain	·	·	✓
SRO	Periorbital pain	·	·	✓
SRO	Spinal pain	·	·	✓
SRO	Walking aid user	·	·	✓

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