3KX-18793-33091

4 vaccinations 10 coded responses 29 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 327 / FL
Registered: 2021-01-17

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

2021-01-15
Dose 1 — Moderna
2021-01-17
Registered in v-safe
2021-01-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-01-19
Survey response — days 1–6 daily, dose 1
MedDRA: Facial discomfort — Feeling: Good · Site: Pain

Free text: Evening after the injection the skin on my face felt prickly but no rash or red soreness. It went away.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · 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
Dose 2 — Moderna
2021-02-12
Health check-in — day 28, dose 1
Feeling: Fair

Adult check-in
2021-02-12
Health check-in — day 0, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-02-15
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Chills, Fatigue or tiredness

Adult check-in
2021-02-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-17
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Diarrhea

Adult check-in
2021-02-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-02-19
Survey response — day 7, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: Itchy scalp face arms/ mild

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-26
Survey response — day 14, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: I am itchy on my scalp, face and arms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-05
Survey response — day 21, dose 2
MedDRA: Paraesthesia, Pre-existing disease, Pruritus — Feeling: Fair

Free text: Itchy. Prickly feeling under my skin in my upper body. No rash or redness. Face/scalp/neck/arms mostly but lower body also. Annoying. Three weeks today since my second shot. I am a very sensitive person. I am also a allergy patient on drops

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-12
Survey response — day 28, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: Itchy off and on for four weeks since second shot February 12

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-19
Survey response — day 35, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-14
Survey response — 3 months, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: Itching

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-08-13
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-09-08
Dose 3 — Moderna
2021-12-08
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-03-09
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-04-14
Dose 4 — Moderna
2022-05-14
Survey response — day 28, dose 4
MedDRA: SARS-CoV-2 test positive — Feeling: Poor · Be unable to do your normal daily activities

Free text: I have tested positive for Covid 19

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Survey response — day 35, dose 4
MedDRA: SARS-CoV-2 test positive — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Tested positive for Covid 19

MedDRA releases: 2024-11 · check-in free text available
2022-05-19
Report sent to call center — day 35, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-20
Call 1 — Left Voicemail
2022-05-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-05-26
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-07-14
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2022-10-13
Survey response — 6 months, dose 4
MedDRA: COVID-19, Cough, Sinusitis — 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, Emergency room or emergency department visit

Free text: Covid, sinus infection, cough

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Report sent to call center — 6 months, dose 4
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
2022-10-14
Call successful
Does not wish to fill out VAERS report

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-15	Moderna
2	2021-02-12	Moderna
3	2021-09-08	Moderna	No
4	2022-04-14	Moderna	No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-19

Systemic reaction (other): Evening after the injection the skin on my face felt prickly but no rash or red soreness. It went away.

Release 4 — day 7, dose 2

2021-02-19

Systemic reaction (other): Itchy scalp face arms/ mild

Release 4 — day 14, dose 2

2021-02-26

Symptoms: I am itchy on my scalp, face and arms.

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Itchy. Prickly feeling under my skin in my upper body. No rash or redness. Face/scalp/neck/arms mostly but lower body also. Annoying. Three weeks today since my second shot. I am a very sensitive person. I am also a allergy patient on drops

Release 5 — day 28, dose 2

2021-03-12

Symptoms: Itchy off and on for four weeks since second shot February 12

Release 5 — day 35, dose 2

2021-03-19

Symptoms: Itching

Release 8 — 3 months, dose 2

2021-05-14

Symptoms: Itching

Release 11 — day 28, dose 4

2022-05-14

Symptoms: I have tested positive for Covid 19

Release 11 — day 35, dose 4

2022-05-19

Symptoms: Tested positive for Covid 19

Release 12 — 6 months, dose 4

2022-10-13

Symptoms: Covid, sinus infection, cough

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	Cough	·	·	✓
SD	COVID-19	·	·	✓
SD	Paraesthesia	✓	✓	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sinusitis	·	·	✓
SRO	Facial discomfort	✓	✓	✓
SRO	Pruritus	✓	✓	✓

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