YR9-42063-44258

2 vaccinations 12 coded responses 26 check-ins 12 free-text entries 4 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 618 / IL
Registered: 2021-01-07

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

2021-01-07
Registered in v-safe
2021-01-07
Dose 1 — Moderna
2021-01-07
Survey response — day 0, dose 1
MedDRA: Headache, Pre-existing disease — Feeling: Good · Headache, Fatigue or tiredness

Free text: I also had a headache yesterday, before receiving the vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-08
Survey response — days 1–6 daily, dose 1
MedDRA: Pre-existing disease, Tooth abscess, Unevaluable event — Feeling: Fair · Site: Pain · Headache · Get care from a doctor or other healthcare professional

Free text: Systemic reaction (other): I have an abcessed tooth, unrelated to vax · Healthcare visit (other): Dental for tooth (unrelated to vax

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-08
Report sent to call center — days 1–6 daily, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-01-09
Survey response — days 1–6 daily, dose 1
MedDRA: Toothache — Feeling: Good · Be unable to work

Free text: Tooth pain-it needs a root canal

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

1 call case(s)
2021-01-10
Survey response — days 1–6 daily, dose 1
MedDRA: Tooth abscess, Toothache — Feeling: Fair

Free text: Still have tooth abscess pain, unrelated to vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in jaw, Tooth abscess, Toothache — Feeling: Fair

Free text: Still dealing with tooth/jaw pain from abscess

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-01-28
Survey response — day 21, dose 1
MedDRA: Conjunctivitis, Gingivitis, Hypersensitivity, Pain, Tooth infection — Feeling: Fair · Be unable to work, 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: New allergic reaction to sesameConjunctivitis (was successfully treated a few weeks ago, but now it has recurred)Rotator cuff pain (not new, but worse)Tooth/gum infection (not new)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Report sent to call center — day 21, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-04
Dose 2 — Moderna
2021-02-04
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Haemorrhoids, Rectal haemorrhage — Feeling: Good · Site: Pain, Swelling · Diarrhea

Free text: Rectal bleeding (maybe hemorrhoids, but seemed like more than usual)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Anal incontinence, Mucous stools — Feeling: Fair · Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Fecal incontinence with quantities of mucous

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Survey response — days 1–6 daily, dose 2
MedDRA: Diarrhoea — Feeling: Fair · Headache, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Still passing a lot of mucous with diarrhea

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Mucous stools — Feeling: Fair · Fever · Nausea, Diarrhea, Abdominal pain

Free text: Mucous in stool (sometimes passing just mucous)

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: Clostridium difficile infection, Toothache — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, 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: I was diagnosed with c.diff today (took clindamycin for tooth pain recently). Started treatment late this afternoon.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Report sent to call center — days 1–6 daily, dose 2
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-02-11
Survey response — day 7, dose 2
MedDRA: Clostridium difficile colitis — Feeling: Fair · Muscle or body aches, Nausea, Diarrhea

Free text: Started treatment for c.diff

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-12
Call 1 — Left Voicemail
2021-02-18
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-02-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 42, dose 2
Feeling: Fair

Adult check-in
2021-05-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-06-08
Call successful
Does not wish to fill out VAERS report
2021-08-07
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-02-04
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-04	Moderna

Call center

Reported	Outcome	VAERS-related outcome
2021-01-08	Unsuccessful
2021-01-09	Unsuccessful
2021-01-28	Successful	Does not wish to fill out VAERS report
2021-02-10	Successful 2021-06-08	Does not wish to fill out VAERS report

Free text

Release 1 — day 0, dose 1

2021-01-07

Systemic reaction (other): I also had a headache yesterday, before receiving the vaccine

Release 1 — days 1–6 daily, dose 1

2021-01-08

Systemic reaction (other): I have an abcessed tooth, unrelated to vax

Healthcare visit (other): Dental for tooth (unrelated to vax

2021-01-09

Systemic reaction (other): Tooth pain-it needs a root canal

2021-01-10

Systemic reaction (other): Still have tooth abscess pain, unrelated to vaccine

2021-01-12

Systemic reaction (other): Still dealing with tooth/jaw pain from abscess

Release 2 — day 21, dose 1

2021-01-28

Symptoms: New allergic reaction to sesameConjunctivitis (was successfully treated a few weeks ago, but now it has recurred)Rotator cuff pain (not new, but worse)Tooth/gum infection (not new)

Release 3 — days 1–6 daily, dose 2

2021-02-05

Systemic reaction (other): Rectal bleeding (maybe hemorrhoids, but seemed like more than usual)

2021-02-06

Systemic reaction (other): Fecal incontinence with quantities of mucous

2021-02-07

Systemic reaction (other): Still passing a lot of mucous with diarrhea

2021-02-09

Systemic reaction (other): Mucous in stool (sometimes passing just mucous)

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): I was diagnosed with c.diff today (took clindamycin for tooth pain recently). Started treatment late this afternoon.

Release 4 — day 7, dose 2

2021-02-11

Systemic reaction (other): Started treatment for c.diff

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	Specialist consultation	○	○	○
HCVO	Unevaluable event	✓	✓	✓
SD	Conjunctivitis	✓	✓	✓
SD	Gingivitis	✓	✓	✓
SD	Hypersensitivity	✓	✓	✓
SD	Pain	✓	✓	✓
SD	Tooth infection	✓	✓	✓
SRO	Anal incontinence	✓	✓	✓
SRO	Clostridium difficile colitis	✓	✓	✓
SRO	Clostridium difficile infection	✓	✓	✓
SRO	Diarrhoea	✓	✓	✓
SRO	Haemorrhoids	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Mucous stools	✓	✓	✓
SRO	Pain in jaw	✓	✓	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rectal haemorrhage	✓	✓	✓
SRO	Tooth abscess	✓	✓	✓
SRO	Toothache	✓	✓	✓
SRO	Unevaluable event	○	○	○

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