4UC-19094-10453

3 vaccinations 4 coded responses 37 check-ins 3 free-text entries 1 call case

Sex: Female
Age at first dose: 66+
ZIP prefix: 559 / MN
Registered: 2021-03-13

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

2021-03-12
Dose 1 — Moderna
2021-03-13
Registered in v-safe
2021-03-13
Survey response — days 1–6 daily, dose 1
MedDRA: Poor quality sleep, Pruritus, Rash — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities

Free text: A mild rash like prickly rash on the tops of my forearms a few hours after I got injected and Restless sleep following the injection on the first night with very itchy feet mostly on the tops but all over my feet

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-14
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-15
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-03-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-03-18
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-03-19
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-03-26
Survey response — day 14, dose 1
MedDRA: Diarrhoea, Headache, Lymphadenopathy, Oropharyngeal pain, Paranasal sinus discomfort, Pyrexia, Rhinorrhoea, Unevaluable event — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Diarrhea fever sore throat headache runny nose sinus pressure pressure around my neck swollen glands · Healthcare visit (other): None I can't get away without someone being in contact

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-26
Report sent to call center — day 14, dose 1
Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-02
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-09
Survey response — day 28, dose 1
MedDRA: Rash pruritic — Feeling: Fair

Free text: I have an itchy rash that has appeared may or may not be from vaccine

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Dose 2 — Moderna
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-19
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-20
Health check-in — day 7, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-27
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-11
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-18
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-13
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-14
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-03-15
Call successful
Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
2022-04-13
Health check-in — 12 months, dose 2
Feeling: Good

Adult check-in
2022-10-22
Dose 3 — Moderna
2022-10-23
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-10-24
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-10-29
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-11-05
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-11-12
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-11-19
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-11-26
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-12-03
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2023-01-21
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2023-04-24
Survey response — 6 months, dose 3
MedDRA: Atypical pneumonia, COVID-19, Nasopharyngitis, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-12	Moderna
2	2021-04-13	Moderna
3	2022-10-22	Moderna	No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-13

Systemic reaction (other): A mild rash like prickly rash on the tops of my forearms a few hours after I got injected and Restless sleep following the injection on the first night with very itchy feet mostly on the tops but all over my feet

Release 6 — day 14, dose 1

2021-03-26

Symptoms: Diarrhea fever sore throat headache runny nose sinus pressure pressure around my neck swollen glands

Healthcare visit (other): None I can't get away without someone being in contact

Release 7 — day 28, dose 1

2021-04-09

Symptoms: I have an itchy rash that has appeared may or may not be from vaccine

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
HCVO	Unevaluable event	✓	✓	✓
SD	Atypical pneumonia	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Headache	✓	✓	✓
SD	Lymphadenopathy	✓	✓	✓
SD	Nasopharyngitis	·	·	✓
SD	Oropharyngeal pain	✓	✓	✓
SD	Paranasal sinus discomfort	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Pyrexia	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	Rhinorrhoea	✓	✓	✓
SRO	Poor quality sleep	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Rash	✓	✓	✓

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