5J4-27210-30666

3 vaccinations 9 coded responses 33 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 46-50
ZIP prefix: 812 / CO
Registered: 2021-04-16

Relationship: Self
Race: Asian
Ethnicity: Not Hispanic or Latino

Registered dependents

BSF-21747-24115 Child or adolescent in my care · Female · 2021-11-05

Timeline Vaccinations Free text MedDRA terms

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-04-14
Dose 1 — Moderna
2021-04-16
Registered in v-safe
2021-04-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2021-04-20
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-04-21
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-28
Survey response — day 14, dose 1
MedDRA: Injection site erythema, Injection site pruritus — Feeling: Good

Free text: Redness and itchy on arm near the injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-05
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-05-12
Dose 2 — Moderna
2021-05-12
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-14
Survey response — days 1–6 daily, dose 2
MedDRA: Pyrexia — Feeling: Good · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Low grade fever 100.1 yesterday evening after I completed the check in.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — days 1–6 daily, dose 2
MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Mild swelling started yesterday evening and continuing today in left armpit lymph node area. Same side as injection.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-16
Survey response — days 1–6 daily, dose 2
MedDRA: Oedema peripheral — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness

Free text: Mild swelling left armpit.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-17
Survey response — days 1–6 daily, dose 2
MedDRA: Oedema peripheral — Feeling: Good · Site: Swelling, Itching · Headache

Free text: Very mild armpit swelling left side.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-18
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · Headache

Adult check-in
2021-05-19
Health check-in — day 7, dose 2
Feeling: Good · Site: Itching · Fatigue or tiredness

Adult check-in
2021-05-26
Survey response — day 14, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: Mild edema and itchy lower legs. Itchy forearms.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-10
Survey response — day 28, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: Itchy lower legs and arms for a couple of days. Has resolved.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-16
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-23
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-11
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-11-11
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-17
Dose 3 — Moderna
2021-11-18
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-19
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling · Headache, Joint pains, Fatigue or tiredness

Adult check-in
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-21
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema peripheral — Feeling: Good · Site: Itching · Joint pains

Free text: Mild armpit swelling on side of shot.

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Joint pains

Adult check-in
2021-11-24
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2021-12-01
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-09
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-15
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-12-29
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-18
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-18
Survey response — 6 months, dose 3
MedDRA: Pre-existing disease — Feeling: Good

Free text: Seasonal allergies.

MedDRA releases: 2024-11 · check-in free text available
2022-11-17
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-14	Moderna
2	2021-05-12	Moderna
3	2021-11-17	Moderna	No

Free text

Release 8 — day 14, dose 1

2021-04-28

Symptoms: Redness and itchy on arm near the injection site.

Release 8 — days 1–6 daily, dose 2

2021-05-14

Systemic reaction (other): Low grade fever 100.1 yesterday evening after I completed the check in.

2021-05-15

Systemic reaction (other): Mild swelling started yesterday evening and continuing today in left armpit lymph node area. Same side as injection.

2021-05-16

Systemic reaction (other): Mild swelling left armpit.

2021-05-17

Systemic reaction (other): Very mild armpit swelling left side.

Release 8 — day 14, dose 2

2021-05-26

Symptoms: Mild edema and itchy lower legs. Itchy forearms.

Release 9 — day 28, dose 2

2021-06-10

Symptoms: Itchy lower legs and arms for a couple of days. Has resolved.

Release 10 — days 1–6 daily, dose 3

2021-11-21

Systemic reaction (other): Mild armpit swelling on side of shot.

Release 11 — 6 months, dose 3

2022-05-18

Symptoms: Seasonal allergies.

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	Injection site erythema	✓	✓	✓
SD	Injection site pruritus	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	✓	✓	✓
SRO	Lymphadenopathy	✓	✓	✓
SRO	Oedema peripheral	✓	✓	✓
SRO	Pyrexia	✓	✓	✓

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