36C-16316-78032

2 vaccinations 12 coded responses 23 check-ins 12 free-text entries 0 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 283 / NC
Registered: 2021-01-16

Relationship: Self
Race: Black or African American
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

2021-01-15
Dose 1 — Moderna
2021-01-16
Registered in v-safe
2021-01-16
Survey response — days 1–6 daily, dose 1
MedDRA: Injection site pain, Injection site pruritus — Feeling: Good · Site: Itching

Free text: Soreness around injection site and minor itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-18
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good · Site: Itching

Free text: Mild itching on arm injected

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Pruritus — Feeling: Good · Site: Itching

Free text: Mild itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-21
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-22
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-01-29
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-02-12
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-02-16
Dose 2 — Moderna
2021-02-16
Health check-in — day 0, dose 2
Feeling: Fair · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-02-17
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Fair · Site: Itching · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Soreness around injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain — Feeling: Fair · Site: Itching · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Soreness around injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-19
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site pain, Skin exfoliation — Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Flaky skin on legs and arms. Soreness around injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-20
Survey response — days 1–6 daily, dose 2
MedDRA: Dry skin, Injection site pain, Skin exfoliation — Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Free text: Dry, flaky skin and soreness around the injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-21
Survey response — days 1–6 daily, dose 2
MedDRA: Dry skin, Injection site pain, Skin exfoliation — Feeling: Good · Site: Swelling, Itching · Fatigue or tiredness

Free text: Flaky, dry skin and soreness around the injection area.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Good · Site: Swelling, Itching · Headache, Fatigue or tiredness, Nausea

Free text: Same as reported previously

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Survey response — day 7, dose 2
MedDRA: Adverse reaction — Feeling: Good · Site: Itching · Fatigue or tiredness, Nausea

Free text: Same as reported previously.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-02
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-09
Survey response — day 21, dose 2
MedDRA: Fatigue, Nausea — Feeling: Good

Free text: Extremely tiredness and frequent nauseousness.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Survey response — day 28, dose 2
MedDRA: Dry skin, Fatigue — Feeling: Good

Free text: Continued tiredness and excessive dry skin.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-23
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-30
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-18
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-16	Moderna

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-16

Systemic reaction (other): Soreness around injection site and minor itching

2021-01-18

Systemic reaction (other): Mild itching on arm injected

2021-01-19

Systemic reaction (other): Mild itching

Release 4 — days 1–6 daily, dose 2

2021-02-17

Systemic reaction (other): Soreness around injection site.

2021-02-18

Systemic reaction (other): Soreness around injection site

2021-02-19

Systemic reaction (other): Flaky skin on legs and arms. Soreness around injection site.

2021-02-20

Systemic reaction (other): Dry, flaky skin and soreness around the injection site.

2021-02-21

Systemic reaction (other): Flaky, dry skin and soreness around the injection area.

2021-02-22

Systemic reaction (other): Same as reported previously

Release 4 — day 7, dose 2

2021-02-23

Systemic reaction (other): Same as reported previously.

Release 5 — day 21, dose 2

2021-03-09

Symptoms: Extremely tiredness and frequent nauseousness.

Release 5 — day 28, dose 2

2021-03-16

Symptoms: Continued tiredness and excessive dry 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	Dry skin	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Nausea	✓	✓	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Dry skin	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Injection site pruritus	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Skin exfoliation	✓	✓	✓

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