355-20014-03501

4 vaccinations 11 coded responses 17 check-ins 11 free-text entries 0 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 207 / MD
Registered: 2021-11-21

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

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-03-06
Dose 1 — Moderna
2021-04-06
Dose 2 — Moderna
2021-11-20
Dose 3 — Pfizer-BioNTech
2021-11-21
Registered in v-safe
2021-11-21
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-11-22
Survey response — days 1–6 daily, dose 3
MedDRA: Chest pain, Pruritus — Feeling: Poor · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Extreme itching and moderate, intermittent chest pains. Note these two symptoms began after Moderna Dose 2

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Adult check-in
2021-11-24
Survey response — days 1–6 daily, dose 3
MedDRA: Chest discomfort, Chest pain, Headache, Pain, Respiratory tract congestion, Self-medication — Feeling: Fair · Headache, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Took Tylenol Sinus today and finally got relief from the headache, congestion and body aches Both of these symptoms started after Moderna dose 2. 1. Random chest pain/tightness (occurred daily almost 2 or 3 times and has tapered off to maybe a few

MedDRA releases: 2024-11 · check-in free text available
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Diarrhea, Abdominal pain

Adult check-in
2021-11-26
Survey response — days 1–6 daily, dose 3
MedDRA: Headache, Pruritus — Feeling: Fair · Headache, Diarrhea, Abdominal pain · Be unable to do your normal daily activities

Free text: Headache was severe. Continue to have random, super itchy skin!

MedDRA releases: 2024-11 · check-in free text available
2021-11-28
Survey response — day 7, dose 3
MedDRA: Chest discomfort, Chest pain, Pruritus — Feeling: Good · Headache, Diarrhea · Be unable to do your normal daily activities

Free text: Random itchy skin and minor chest pain/tightness

MedDRA releases: 2024-11 · check-in free text available
2021-12-04
Survey response — day 14, dose 3
MedDRA: Headache, Tinnitus — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Headache , major one day. Also, my ears have been ringing. Not sure when it started.

MedDRA releases: 2024-11 · check-in free text available
2021-12-13
Survey response — day 21, dose 3
MedDRA: Chest discomfort, Chest pain, Pruritus, Sinus headache, Tinnitus — Feeling: Good

Free text: Ears ringing! Itchy skin continues!! Random chest pain/tightness continues. Sinus headaches.

MedDRA releases: 2024-11 · check-in free text available
2021-12-18
Survey response — day 28, dose 3
MedDRA: Chest discomfort, Chest pain, Injection site discolouration, Pruritus — Feeling: Good · Be unable to do your normal daily activities

Free text: Loss of pigmentation at injection site. Random chest pain/tightness continues. Really random severely itchy skin with no visible rash continues.

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Survey response — day 35, dose 3
MedDRA: Chest discomfort, Chest pain, Pruritus, Rash, Urticaria — Feeling: Fair · Be unable to do your normal daily activities

Free text: Random fiercely itcy skin with no visible rash. Rash/hives appear only when I scratch. Itchiness is unbearable when it occurs. It stops suddenly then hives go away. (Started after Moderna Dose 2 and continues) Random chest pain/tightness continues.

MedDRA releases: 2024-11 · check-in free text available
2022-01-04
Survey response — day 42, dose 3
MedDRA: Chest discomfort, Chest pain, Ear discomfort, Headache, Injection site discolouration, Pruritus, Tinnitus — Feeling: Fair · Be unable to do your normal daily activities

Free text: 1. Ears feel clogged and like there's water 2. Ears constantly ringing 3. Loss of pigmentation at injection site 4. Sudden random itchy skin with no visible rash. 5. Random chest pain/tightness 6. Random headaches

MedDRA releases: 2024-11 · check-in free text available
2022-02-21
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-04
Dose 4 — Pfizer-BioNTech
Co-administered: Shingles
2022-05-19
Survey response — day 14, dose 4
MedDRA: Pain, Pain in extremity — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Sore arms and body aches for the first 24-48 hours

MedDRA releases: 2024-11 · check-in free text available
2022-05-27
Survey response — day 21, dose 4
MedDRA: Pruritus, Tinnitus — Feeling: Good

Free text: Ears ringing!!!!! Still have random itchy skin

MedDRA releases: 2024-11 · check-in free text available
2022-06-01
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-05
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-06	Moderna	No
2	2021-04-06	Moderna	No
3	2021-11-20	Pfizer-BioNTech	No
4	2022-05-04	Pfizer-BioNTech	Shingles

Free text

Release 10 — days 1–6 daily, dose 3

2021-11-22

Systemic reaction (other): Extreme itching and moderate, intermittent chest pains. Note these two symptoms began after Moderna Dose 2

2021-11-24

Systemic reaction (other): Took Tylenol Sinus today and finally got relief from the headache, congestion and body aches Both of these symptoms started after Moderna dose 2. 1. Random chest pain/tightness (occurred daily almost 2 or 3 times and has tapered off to maybe a few cut off by CDC

2021-11-26

Systemic reaction (other): Headache was severe. Continue to have random, super itchy skin!

Release 10 — day 7, dose 3

2021-11-28

Systemic reaction (other): Random itchy skin and minor chest pain/tightness

Release 10 — day 14, dose 3

2021-12-04

Symptoms: Headache , major one day. Also, my ears have been ringing. Not sure when it started.

Release 10 — day 21, dose 3

2021-12-13

Symptoms: Ears ringing! Itchy skin continues!! Random chest pain/tightness continues. Sinus headaches.

Release 10 — day 28, dose 3

2021-12-18

Symptoms: Loss of pigmentation at injection site. Random chest pain/tightness continues. Really random severely itchy skin with no visible rash continues.

Release 10 — day 35, dose 3

2021-12-26

Symptoms: Random fiercely itcy skin with no visible rash. Rash/hives appear only when I scratch. Itchiness is unbearable when it occurs. It stops suddenly then hives go away. (Started after Moderna Dose 2 and continues) Random chest pain/tightness continues. cut off by CDC

Release 10 — day 42, dose 3

2022-01-04

Symptoms: 1. Ears feel clogged and like there's water 2. Ears constantly ringing 3. Loss of pigmentation at injection site 4. Sudden random itchy skin with no visible rash. 5. Random chest pain/tightness 6. Random headaches

Release 11 — day 14, dose 4

2022-05-19

Symptoms: Sore arms and body aches for the first 24-48 hours

Release 11 — day 21, dose 4

2022-05-27

Symptoms: Ears ringing!!!!! Still have random itchy skin

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	Chest discomfort	·	·	✓
SD	Chest pain	·	·	✓
SD	Ear discomfort	·	·	✓
SD	Headache	·	·	✓
SD	Injection site discolouration	·	·	✓
SD	Pain	·	·	✓
SD	Pain in extremity	·	·	✓
SD	Pruritus	·	·	✓
SD	Rash	·	·	✓
SD	Sinus headache	·	·	✓
SD	Tinnitus	·	·	✓
SD	Urticaria	·	·	✓
SRO	Chest discomfort	·	·	✓
SRO	Chest pain	·	·	✓
SRO	Headache	·	·	✓
SRO	Pain	·	·	✓
SRO	Pruritus	·	·	✓
SRO	Respiratory tract congestion	·	·	✓
SRO	Self-medication	·	·	✓

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