49B-17759-14290

5 vaccinations 14 coded responses 43 check-ins 12 free-text entries 0 call cases

Sex: Male
Age at first dose: 66+
ZIP prefix: 190 / PA
Registered: 2021-03-25

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

2021-03-23
Dose 1 — Moderna
2021-03-25
Registered in v-safe
2021-03-25
Survey response — days 1–6 daily, dose 1
MedDRA: Asthenia, Malaise, Myalgia, Peripheral swelling — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: The night of the 23rd March, I experienced malaise weakness and pain and swelling of the deltoid. I feel better today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-02
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-10
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-04-25
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-27
Dose 2 — Moderna
2021-04-28
Survey response — days 1–6 daily, dose 2
MedDRA: Asthenia, Malaise — Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Malaise and weakness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Joint pains, Fatigue or tiredness · Be unable to work

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Diarrhea

Adult check-in
2021-05-08
Survey response — day 7, dose 2
MedDRA: Myalgia — Feeling: Good · Site: Pain · Muscle or body aches

Free text: Muscle achiness in the upper arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-26
Survey response — day 28, dose 2
MedDRA: Fatigue, Sleep disorder — Feeling: Good

Free text: Fatigue, disturbed sleep pattern.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-12
Survey response — day 42, dose 2
MedDRA: Fatigue — Feeling: Good

Free text: Fatigue

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-27
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-26
Survey response — 6 months, dose 2
MedDRA: Arthralgia, Mobility decreased — Feeling: Fair

Free text: Pain in top of shoulder, limited motion of left arm.

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Dose 3 — Moderna
2022-04-29
Survey response — 12 months, dose 2
MedDRA: Peripheral swelling — Feeling: Good

Free text: Swelling feet

MedDRA releases: 2024-11 · check-in free text available
2022-05-13
Dose 4 — Moderna
2022-05-13
Survey response — day 0, dose 4
MedDRA: Malaise, Pain in extremity — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness

Free text: Malaise, pain in the arm

MedDRA releases: 2024-11 · check-in free text available
2022-05-14
Survey response — days 1–6 daily, dose 4
MedDRA: Malaise — Feeling: Poor · Site: Pain · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Malaise

MedDRA releases: 2024-11 · check-in free text available
2022-05-15
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Itching · Joint pains, Fatigue or tiredness

Adult check-in
2022-05-16
Survey response — days 1–6 daily, dose 4
MedDRA: Abdominal discomfort — Feeling: Fair · Site: Itching · Fatigue or tiredness

Free text: stomach upset

MedDRA releases: 2024-11 · check-in free text available
2022-05-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2022-05-18
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-19
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-05-20
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-05-27
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-06-03
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-06-10
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-06-17
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-06-24
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2022-08-13
Survey response — 3 months, dose 4
MedDRA: Arthralgia, Pain, Peripheral swelling — Feeling: Good

Free text: Pain in right knee during motion, and swelling of right foot.

MedDRA releases: 2024-11 · check-in free text available
2022-10-20
Dose 5 — Moderna
2022-10-20
Health check-in — day 0, dose 5
Feeling: Good · Site: Pain · None

Adult check-in
2022-10-21
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Itching · Fever · Headache, Muscle or body aches

Adult check-in
2022-10-22
Health check-in — days 1–6 daily, dose 5
Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2022-10-23
Health check-in — days 1–6 daily, dose 5
Feeling: Good · Site: Itching · None

Adult check-in
2022-10-25
Health check-in — days 1–6 daily, dose 5
Feeling: Good · None

Adult check-in
2022-10-27
Health check-in — day 7, dose 5
Feeling: Good · Site: Itching · None

Adult check-in
2022-11-03
Survey response — day 14, dose 5
MedDRA: Injection site pruritus, Injection site rash — Feeling: Good

Free text: Itching at injection site and small rash at site.

MedDRA releases: 2024-11 · check-in free text available
2022-11-10
Health check-in — day 21, dose 5
Feeling: Good

Adult check-in
2022-11-18
Health check-in — day 28, dose 5
Feeling: Good

Adult check-in
2022-11-26
Health check-in — day 35, dose 5
Feeling: Good

Adult check-in
2022-12-01
Health check-in — day 42, dose 5
Feeling: Good

Adult check-in
2023-01-19
Survey response — 3 months, dose 5
MedDRA: Dermatitis acneiform, Rash, Scratch — Feeling: Good

MedDRA releases: 2024-11
2023-04-21
Survey response — 6 months, dose 5
MedDRA: Rash — Feeling: Fair

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-23	Moderna
2	2021-04-27	Moderna
3	2021-11-22	Moderna	No
4	2022-05-13	Moderna	No
5	2022-10-20	Moderna	No

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-25

Systemic reaction (other): The night of the 23rd March, I experienced malaise weakness and pain and swelling of the deltoid. I feel better today.

Release 8 — days 1–6 daily, dose 2

2021-04-28

Systemic reaction (other): Malaise and weakness

Release 8 — day 7, dose 2

2021-05-08

Systemic reaction (other): Muscle achiness in the upper arm.

Release 8 — day 28, dose 2

2021-05-26

Symptoms: Fatigue, disturbed sleep pattern.

Release 9 — day 42, dose 2

2021-06-12

Symptoms: Fatigue

Release 10 — 6 months, dose 2

2021-10-26

Symptoms: Pain in top of shoulder, limited motion of left arm.

Release 11 — 12 months, dose 2

2022-04-29

Symptoms: Swelling feet

Release 11 — day 0, dose 4

2022-05-13

Systemic reaction (other): Malaise, pain in the arm

Release 11 — days 1–6 daily, dose 4

2022-05-14

Systemic reaction (other): Malaise

2022-05-16

Systemic reaction (other): stomach upset

Release 12 — 3 months, dose 4

2022-08-13

Symptoms: Pain in right knee during motion, and swelling of right foot.

Release 12 — day 14, dose 5

2022-11-03

Symptoms: Itching at injection site and small rash at site.

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	Arthralgia	·	·	✓
SD	Dermatitis acneiform	·	·	✓
SD	Fatigue	✓	✓	✓
SD	Injection site pruritus	·	·	✓
SD	Injection site rash	·	·	✓
SD	Mobility decreased	·	·	✓
SD	Pain	·	·	✓
SD	Peripheral swelling	·	·	✓
SD	Rash	·	·	✓
SD	Scratch	·	·	✓
SD	Sleep disorder	✓	✓	✓
SRO	Abdominal discomfort	·	·	✓
SRO	Asthenia	✓	✓	✓
SRO	Malaise	✓	✓	✓
SRO	Myalgia	✓	✓	✓
SRO	Pain in extremity	·	·	✓
SRO	Peripheral swelling	✓	✓	✓

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