UA6-29296-31200

4 vaccinations 17 coded responses 30 check-ins 16 free-text entries 7 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 112 / NY
Registered: 2021-01-10

Relationship: Self
Race: Black or African American
Ethnicity: Not Hispanic or Latino

Registered dependents

DKD-11237-55791 Child or adolescent in my care · Female · 2022-04-27

AJM-11470-08116 Child or adolescent in my care · Female · 2022-12-11

Timeline

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

2021-01-10
Registered in v-safe
2021-01-10
Dose 1 — Moderna
2021-01-10
Survey response — day 0, dose 1
MedDRA: Throat irritation, Vision blurred — Feeling: Good · Site: Pain · Headache

Free text: Slight blurry vision and burning in throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Survey response — days 1–6 daily, dose 1
MedDRA: Breast feeding, Systemic lupus erythematosus — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Breastfeeding a 5 week old baby who was born premature at 35 weeks. I am diagnosed with Lupus.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-01-12
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-14
Survey response — days 1–6 daily, dose 1
MedDRA: Breast feeding — Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Breastfeed

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-14
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-15
Survey response — days 1–6 daily, dose 1
MedDRA: Breast feeding — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: I am breastfeeding a 5 week old preemie.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-15
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Breast feeding — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Breastfeeding a 35 week preemie who is 5 weeks old

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-16
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-17
Survey response — day 7, dose 1
MedDRA: Breast feeding — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Breastfeeding a preemie born at 35 weeks and is currently 6 weeks old.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Report sent to call center — day 7, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-24
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-01-31
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-07
Dose 2 — Moderna
2021-02-07
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-08
Survey response — days 1–6 daily, dose 2
MedDRA: Breast feeding, Pre-existing disease — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Lupus. Breastfeeding 2 month old preemie

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Breast feeding, Systemic lupus erythematosus — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Lupus and breastfeeding a 2 month old preemie

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Breast feeding, Pre-existing disease, Systemic lupus erythematosus — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lupus; breastfeeding a 2 month old preemie.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — days 1–6 daily, dose 2
MedDRA: Breast feeding, Systemic lupus erythematosus — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lupus diagnosis and breastfeeding a 2 month old baby who was born at 35 weeks premature.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-13
Survey response — days 1–6 daily, dose 2
MedDRA: Breast feeding, Pre-existing disease — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lupus and breastfeeding a 35 born preemie who is currently 9 weeks old.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-14
Survey response — day 7, dose 2
MedDRA: Breast feeding, Systemic lupus erythematosus — Feeling: Fair · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lupus diagnosis and breastfeeding a 35 week preemie who is currently 9 weeks old.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-02-28
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-03-07
Health check-in — day 28, dose 2
Feeling: Fair

Adult check-in
2021-03-14
Health check-in — day 35, dose 2
Feeling: Fair

Adult check-in
2021-03-21
Survey response — day 42, dose 2
MedDRA: Injection site erythema, Injection site pruritus, Injection site rash — Feeling: Fair

Free text: Rash on my left arm where my shot was administered. Rash is raised and itchy. Rash is red and large and changes spots.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — 3 months, dose 2
MedDRA: Pain in extremity — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain in the arm where the vaccine was administered.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-08
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Joint swelling — Feeling: Fair · Be unable to do your normal daily activities

Free text: Pain and swelling in left ankle.

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-11-24
Dose 3 — Moderna
2022-02-07
Health check-in — 12 months, dose 2
Feeling: Fair

Adult check-in
2022-05-25
Survey response — 6 months, dose 3
MedDRA: Pain — Feeling: Fair · Be unable to do your normal daily activities

Free text: Body aches.

MedDRA releases: 2024-11 · check-in free text available
2022-10-26
Dose 4 — Moderna
2022-11-24
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in
2022-12-11
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-12-11
Health check-in — days 1–6 daily, dose 3, under 3
Feeling: Fair · Site: Swelling/hardness · Fever · Sleepiness, Irritability/crying, Loss of appetite

Under 3 check-in
2023-01-25
Health check-in — 3 months, dose 4
Feeling: Fair

Adult check-in
2023-04-26
Survey response — 6 months, dose 4
MedDRA: Office visit, Pregnancy — Feeling: Fair · Get care from a doctor or other healthcare professional

MedDRA releases: 2024-11
2023-04-26
Report sent to call center — 6 months, dose 4
Get care from a doctor or other healthcare professional

1 call case(s)
2023-04-27
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-10	Moderna
2	2021-02-07	Moderna
3	2021-11-24	Moderna	No
4	2022-10-26	Moderna	No

Call center

7 call center cases

1 successful · 6 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 1 — day 0, dose 1

2021-01-10

Systemic reaction (other): Slight blurry vision and burning in throat

Release 1 — days 1–6 daily, dose 1

2021-01-11

Systemic reaction (other): Breastfeeding a 5 week old baby who was born premature at 35 weeks. I am diagnosed with Lupus.

Release 2 — days 1–6 daily, dose 1

2021-01-14

Systemic reaction (other): Breastfeed

2021-01-15

Systemic reaction (other): I am breastfeeding a 5 week old preemie.

2021-01-16

Systemic reaction (other): Breastfeeding a 35 week preemie who is 5 weeks old

Release 2 — day 7, dose 1

2021-01-17

Systemic reaction (other): Breastfeeding a preemie born at 35 weeks and is currently 6 weeks old.

Release 3 — days 1–6 daily, dose 2

2021-02-08

Systemic reaction (other): Lupus. Breastfeeding 2 month old preemie

2021-02-09

Systemic reaction (other): Lupus and breastfeeding a 2 month old preemie

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Lupus; breastfeeding a 2 month old preemie.

2021-02-11

Systemic reaction (other): Lupus diagnosis and breastfeeding a 2 month old baby who was born at 35 weeks premature.

2021-02-13

Systemic reaction (other): Lupus and breastfeeding a 35 born preemie who is currently 9 weeks old.

Release 4 — day 7, dose 2

2021-02-14

Systemic reaction (other): Lupus diagnosis and breastfeeding a 35 week preemie who is currently 9 weeks old.

Release 6 — day 42, dose 2

2021-03-21

Symptoms: Rash on my left arm where my shot was administered. Rash is raised and itchy. Rash is red and large and changes spots.

Release 8 — 3 months, dose 2

2021-05-11

Symptoms: Pain in the arm where the vaccine was administered.

Release 9 — 6 months, dose 2

2021-08-08

Symptoms: Pain and swelling in left ankle.

Release 11 — 6 months, dose 3

2022-05-25

Symptoms: Body aches.

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	Arthralgia	✓	·	✓
SD	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Joint swelling	✓	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Pregnancy	·	·	✓
SRO	Breast feeding	✓	✓	✓
SRO	Maternal exposure during breast feeding	○	○	○
SRO	Pre-existing disease	✓	✓	✓
SRO	Systemic lupus erythematosus	✓	✓	✓
SRO	Throat irritation	✓	✓	✓
SRO	Vision blurred	✓	✓	✓

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