4EX-11014-80863

2 vaccinations 8 coded responses 24 check-ins 8 free-text entries 0 call cases

Sex: Female
Age at first dose: 26-30
ZIP prefix: 152 / PA
Registered: 2021-02-08

Relationship: Self
Race: Other
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

2021-02-08
Registered in v-safe
2021-02-08
Dose 1 — Moderna
2021-02-08
Health check-in — day 0, dose 1
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 1
MedDRA: Feeling abnormal, Pain in extremity — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Arm pain wasn't that bad until about 6 hours after the injection and then it felt.like a zombie.ripped.it.off

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-02-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-15
Survey response — day 7, dose 1
MedDRA: Injection site pain, Pain, Pain in extremity — Feeling: Good · Site: Pain, Redness · Muscle or body aches · Be unable to do your normal daily activities

Free text: All of a sudden my arm starting hurting today around injection site. It is sore and Ipainful for me to lift my arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-22
Survey response — day 14, dose 1
MedDRA: Skin discolouration — Feeling: Good

Free text: I notice that my skin pigment color had changed where I received the dosage on my arm. It is the size of a quarter and is ghost white. It came 1.5 weeks after the shot and has not gone away. It is very noticeable but no pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-03-08
Dose 2 — Moderna
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-10
Survey response — days 1–6 daily, dose 2
MedDRA: Pigmentation disorder, Vaccination site discolouration — Feeling: Good · Site: Pain, Redness, Swelling · Headache

Free text: I have still no pigment in my skin from the area of my first vaccine dose. I

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-11
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-12
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site bruising, Injection site discolouration — Feeling: Good · Site: Redness, Swelling

Free text: A new bruise at vaccination site. My skin pigment/color has also not returned. It is the size of a quarter

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-13
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-14
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-15
Health check-in — day 7, dose 2
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-19
Survey response — day 42, dose 2
MedDRA: Nasopharyngitis — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities

Free text: Cold like symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Survey response — 3 months, dose 2
MedDRA: Nasopharyngitis — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities

Free text: Cold like symptoms

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-09-08
Survey response — 6 months, dose 2
MedDRA: Nasopharyngitis — Feeling: Fair · Be unable to do your normal daily activities

Free text: Cold symptoms

MedDRA releases: 2024-11 · check-in free text available
2022-03-08
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-08	Moderna
2	2021-03-08	Moderna

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-09

Systemic reaction (other): Arm pain wasn't that bad until about 6 hours after the injection and then it felt.like a zombie.ripped.it.off

Release 4 — day 7, dose 1

2021-02-15

Systemic reaction (other): All of a sudden my arm starting hurting today around injection site. It is sore and Ipainful for me to lift my arm

Release 4 — day 14, dose 1

2021-02-22

Symptoms: I notice that my skin pigment color had changed where I received the dosage on my arm. It is the size of a quarter and is ghost white. It came 1.5 weeks after the shot and has not gone away. It is very noticeable but no pain

Release 5 — days 1–6 daily, dose 2

2021-03-10

Systemic reaction (other): I have still no pigment in my skin from the area of my first vaccine dose. I

2021-03-12

Systemic reaction (other): A new bruise at vaccination site. My skin pigment/color has also not returned. It is the size of a quarter

Release 7 — day 42, dose 2

2021-04-19

Symptoms: Cold like symptoms

Release 9 — 3 months, dose 2

2021-06-09

Symptoms: Cold like symptoms

Release 9 — 6 months, dose 2

2021-09-08

Symptoms: Cold symptoms

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	Nasopharyngitis	✓	✓	✓
SD	Skin discolouration	✓	✓	✓
SRO	Feeling abnormal	✓	✓	✓
SRO	Injection site bruising	✓	✓	✓
SRO	Injection site discolouration	✓	✓	✓
SRO	Injection site pain	✓	✓	✓
SRO	Pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pigmentation disorder	○	✓	○
SRO	Vaccination site discolouration	✓	·	✓

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