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3NA-18307-86035

2 vaccinations 4 coded responses 22 check-ins 4 free-text entries 1 call case
Sex
Male
Age at first dose
16-20
ZIP prefix
183 / PA
Registered
2021-02-05
Relationship
Self
Race
White
Ethnicity
Hispanic or Latino

Timeline

  1. 2021-02-05
    Registered in v-safe
  2. 2021-02-05
    Dose 1 — Moderna
  3. 2021-02-05
    Health check-in — day 0, dose 1
    Feeling: Fair · Site: Pain · Fatigue or tiredness
    Adult check-in
  4. 2021-02-06
    Health check-in — days 1–6 daily, dose 1
    Feeling: Poor · Site: Pain · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to work
    Adult check-in
  5. 2021-02-07
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  6. 2021-02-09
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-02-10
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Headache
    Adult check-in
  8. 2021-02-12
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-02-19
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-02-26
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-03-05
    Dose 2 — Moderna
  12. 2021-03-05
    Health check-in — day 0, dose 2
    Feeling: Fair · Site: Pain · Fatigue or tiredness
    Adult check-in
  13. 2021-03-06
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness
    Adult check-in
  14. 2021-03-07
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · Headache
    Adult check-in
  15. 2021-03-09
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pruritus, Rash, Urticaria — Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection site
    Free text: Non anaphylactic rashes and hives along lower back. Lower left arm also itchy but no signs of hives
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-03-10
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-03-12
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-03-19
    Survey response — day 14, dose 2
    MedDRA: Rash, Self-medication, Skin irritation — Feeling: Good
    Free text: Constant skin irritation and rashes appearing at night. Goes away with antihistamines
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-03-26
    Survey response — day 21, dose 2
    MedDRA: Hypersensitivity — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Clear allergic reactions still appearing on skin since second day after second injection. Its gotten worse, 2 12hr doses of Allegra is the only thing to subdue affects. Seeking provider Monday March 30th
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  20. 2021-04-04
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-04-09
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-04-18
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-06-04
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-09-03
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  25. 2022-03-05
    Survey response — 12 months, dose 2
    MedDRA: Malaise, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend school, 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: Tested positive for Covid. Had extremely similar symptoms with a negative test 3 weeks later.
    MedDRA releases: 2024-11 · check-in free text available
  26. 2022-03-05
    Report sent to call center — 12 months, dose 2
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
  27. 2022-03-08

Vaccinations

DoseDateManufacturerCo-administered
12021-02-05Moderna
22021-03-05Moderna

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-09

Systemic reaction (other): Non anaphylactic rashes and hives along lower back. Lower left arm also itchy but no signs of hives

Release 5 — day 14, dose 2

2021-03-19

Symptoms: Constant skin irritation and rashes appearing at night. Goes away with antihistamines

Release 6 — day 21, dose 2

2021-03-26

Symptoms: Clear allergic reactions still appearing on skin since second day after second injection. Its gotten worse, 2 12hr doses of Allegra is the only thing to subdue affects. Seeking provider Monday March 30th

Release 11 — 12 months, dose 2

2022-03-05

Symptoms: Tested positive for Covid. Had extremely similar symptoms with a negative test 3 weeks later.

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

FieldPreferred term2021-092023-042024-11
SDHypersensitivity ✓ ✓ ✓
SDMalaise · · ✓
SDRash ✓ ✓ ✓
SDSARS-CoV-2 test negative · · ✓
SDSARS-CoV-2 test positive · · ✓
SDSelf-medication ✓ ✓ ✓
SDSkin irritation ✓ ✓ ✓
SROPruritus ✓ ✓ ✓
SRORash ✓ ✓ ✓
SROUrticaria ✓ ✓ ✓

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

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