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5GE-18743-75290

5 vaccinations 6 coded responses 32 check-ins 5 free-text entries 1 call case
Sex
Female
Age at first dose
66+
ZIP prefix
481 / MI
Registered
2021-02-13
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-20
    Dose 1 — Moderna
  2. 2021-02-13
    Registered in v-safe
  3. 2021-02-13
    Survey response — day 21, dose 1
    MedDRA: Blister, Injection site pruritus, Injection site urticaria, Pain in extremity — Feeling: Good
    Free text: Sore arm on the 01/20 - gone w/in 24hrs. But on, 01/25/21, experienced 3 small itchy hives within a few inches of injection point, lasting ~ 2hrs. On 01/26/21, 1.5mm itchy blister on right foot appeared, lasting ~ 2hrs. No other unusual symptoms.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-17
    Dose 2 — Moderna
  5. 2021-02-17
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  6. 2021-02-18
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Itching · None
    Adult check-in
  7. 2021-02-19
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · None
    Adult check-in
  8. 2021-02-20
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  9. 2021-02-21
    Survey response — days 1–6 daily, dose 2
    MedDRA: Arthralgia — Feeling: Good · Joint pains
    Free text: woke up with unexplained joint pain with 2 toes to left of big toe on left foot - lasted ~ 2hrs
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-02-22
    Survey response — days 1–6 daily, dose 2
    MedDRA: Muscle spasms — Feeling: Good · Muscle or body aches
    Free text: Right leg calf muscle feels/acts like it wants to "cramp" or "seize/lock up
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-02-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  12. 2021-02-24
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  13. 2021-03-03
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-03-10
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-03-17
    Survey response — day 28, dose 2
    MedDRA: Injection site erythema, Injection site swelling — Feeling: Good
    Free text: Near injection site - 2 mm red bump appeared 16-Mar persisting on 17-Mar - not itchy, not sore
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-03-24
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-03-31
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-05-19
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  19. 2021-08-18
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-11-12
    Dose 3 — Moderna
  21. 2022-02-17
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in
  22. 2022-03-31
    Dose 4 — Moderna
  23. 2022-10-10
    Dose 5 — Moderna
  24. 2022-10-10
    Health check-in — day 0, dose 5
    Feeling: Good · Site: Pain · None
    Adult check-in
  25. 2022-10-11
    Survey response — days 1–6 daily, dose 5
    MedDRA: Pain, Pain in extremity — Feeling: Good · Site: Itching · Muscle or body aches
    Free text: RE: body ache -abt. 12 hrs after shot (left arm), abruptly started experienced "throb" type pain midway between where the left leg joins the torso and the vulva region. Still present as of this report.
    MedDRA releases: 2024-11 · check-in free text available
  26. 2022-10-12
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  27. 2022-10-13
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  28. 2022-10-14
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  29. 2022-10-15
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  30. 2022-10-16
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  31. 2022-10-17
    Health check-in — day 7, dose 5
    Feeling: Good · None
    Adult check-in
  32. 2022-10-24
    Health check-in — day 14, dose 5
    Feeling: Good
    Adult check-in
  33. 2022-10-31
    Health check-in — day 21, dose 5
    Feeling: Good
    Adult check-in
  34. 2022-11-07
    Health check-in — day 28, dose 5
    Feeling: Good
    Adult check-in
  35. 2022-11-14
    Health check-in — day 35, dose 5
    Feeling: Good
    Adult check-in
  36. 2022-11-21
    Health check-in — day 42, dose 5
    Feeling: Good
    Adult check-in
  37. 2023-01-10
    Health check-in — 3 months, dose 5
    Feeling: Good
    Adult check-in
  38. 2023-04-10
    Survey response — 6 months, dose 5
    MedDRA: Dyshidrotic eczema, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional
    MedDRA releases: 2024-11
  39. 2023-04-10
    Report sent to call center — 6 months, dose 5
    Get care from a doctor or other healthcare professional
    1 call case(s)
  40. 2023-04-11
  41. 2023-04-12
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill

Vaccinations

DoseDateManufacturerCo-administered
12021-01-20Moderna
22021-02-17Moderna
32021-11-12Moderna No
42022-03-31Moderna No
52022-10-10Moderna No

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — day 21, dose 1

2021-02-13

Symptoms: Sore arm on the 01/20 - gone w/in 24hrs. But on, 01/25/21, experienced 3 small itchy hives within a few inches of injection point, lasting ~ 2hrs. On 01/26/21, 1.5mm itchy blister on right foot appeared, lasting ~ 2hrs. No other unusual symptoms. cut off by CDC

Release 4 — days 1–6 daily, dose 2

2021-02-21

Systemic reaction (other): woke up with unexplained joint pain with 2 toes to left of big toe on left foot - lasted ~ 2hrs

2021-02-22

Systemic reaction (other): Right leg calf muscle feels/acts like it wants to "cramp" or "seize/lock up

Release 5 — day 28, dose 2

2021-03-17

Symptoms: Near injection site - 2 mm red bump appeared 16-Mar persisting on 17-Mar - not itchy, not sore

Release 12 — days 1–6 daily, dose 5

2022-10-11

Systemic reaction (other): RE: body ache -abt. 12 hrs after shot (left arm), abruptly started experienced "throb" type pain midway between where the left leg joins the torso and the vulva region. Still present as of this report.

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
HCVOOffice visit · · ✓
SDBlister ✓ ✓ ✓
SDDyshidrotic eczema · · ✓
SDInjection site erythema ✓ ✓ ✓
SDInjection site pruritus ✓ ✓ ✓
SDInjection site swelling ✓ ✓ ✓
SDInjection site urticaria ✓ ✓ ✓
SDPain in extremity ✓ ✓ ✓
SROArthralgia ✓ ✓ ✓
SROMuscle spasms ✓ ✓ ✓
SROPain · · ✓
SROPain in extremity · · ✓

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