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5TP-77882-45757

2 vaccinations 8 coded responses 13 check-ins 8 free-text entries 0 call cases
Sex
—
Age at first dose
61-65
ZIP prefix
940 / CA
Registered
2021-01-29
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-16
    Dose 1 — Moderna
  2. 2021-01-29
    Registered in v-safe
  3. 2021-01-29
    Health check-in — day 7, dose 1
    Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities
    Adult check-in
  4. 2021-02-06
    Survey response — day 21, dose 1
    MedDRA: Fatigue, Headache, Rash — Feeling: Fair
    Free text: More rash. Vaccination arm (left), neck and face on same side. Waves of tiredness and headache
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-02-10
    Dose 2 — Moderna
  6. 2021-02-11
    Survey response — days 1–6 daily, dose 2
    MedDRA: Ear discomfort, Ear pain, Eye irritation, Headache, Lymphadenopathy, Muscle tightness, Pain in jaw, Pyrexia, Self-medication, Sensitive skin, Tenderness — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities
    Free text: My jaw tightened up right after the shot and still hurts a lot. My my ears I stuffy and painful. My gums teeth and sinuses And my eyes are burning. I have swollen glands on my neck. Also my skin is so sensitive it hurts to touch in places Like all the nerves are right on the edge. Not not super serious, I am lying down and I have to breathe short shallow breaths to keep my head from hurting a lot. I did take ibuprofen cold and flu because I had a zoom meeting, the fever went down to 97.8 and I felt a lot better Then when it wore off I got worse again.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-02-12
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  8. 2021-02-13
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  9. 2021-02-15
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  10. 2021-02-17
    Survey response — day 7, dose 2
    MedDRA: Injection site pruritus, Injection site rash, Injection site urticaria, Rash — Feeling: Good · Site: Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness
    Free text: I got my second vaccination in the opposite arm as the first. Both times I have gotten a rash and hives about a week after the injection. I still have itching in periodic hive or two on the original on Period the new one now has a rashEnd it moves up to neck and face on the same side as the shot. Nothing dramatic.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-02-26
    Survey response — day 14, dose 2
    MedDRA: Arthralgia, Bone pain, Fatigue, Headache, Pain, Rash — Feeling: Good
    Free text: I just still have a rash. Fatigue. Headache. Joint, bone, body aches.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-03-05
    Survey response — day 21, dose 2
    MedDRA: Pruritus, Rash, Skin lesion, Urticaria — Feeling: Good
    Free text: Rash, new small itchy hives. Still on arms, small sores on face and jaw.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-03-10
    Survey response — day 28, dose 2
    MedDRA: Pruritus, Urticaria — Feeling: Fair
    Free text: More hives Period itching Period a long shot area and other lymph node areas.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-03-17
    Survey response — day 35, dose 2
    MedDRA: Arthropathy, Bone disorder, Fatigue, Lymphadenopathy, Rash, Urticaria — Feeling: Good
    Free text: The rash and hives are getting worse on my arm neck and face Also the lymph nodes of my legs and armpits. This is just like the rash I got at the start. So I believe it is still from the vaccination Also I still have fatigue joint and bone eggs
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-03-24
    Survey response — day 42, dose 2
    MedDRA: Dysgeusia, Pruritus, Urticaria — Feeling: Good
    Free text: Still have annoying itchy hives and rash along the same places as right after the shot.I feel that I still have the poison in me And it is not flushing out. Every now and then I get the same taste in my mouth that I had when I first got the injec.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-05-12
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-16Moderna
22021-02-10Moderna

Free text

Release 3 — day 21, dose 1

2021-02-06

Symptoms: More rash. Vaccination arm (left), neck and face on same side. Waves of tiredness and headache

Release 4 — days 1–6 daily, dose 2

2021-02-11

Systemic reaction (other): My jaw tightened up right after the shot and still hurts a lot. My my ears I stuffy and painful. My gums teeth and sinuses And my eyes are burning. I have swollen glands on my neck. Also my skin is so sensitive it hurts to touch in places Like all the nerves are right on the edge. Not not super serious, I am lying down and I have to breathe short shallow breaths to keep my head from hurting a lot. I did take ibuprofen cold and flu because I had a zoom meeting, the fever went down to 97.8 and I felt a lot better Then when it wore off I got worse again.

Release 4 — day 7, dose 2

2021-02-17

Systemic reaction (other): I got my second vaccination in the opposite arm as the first. Both times I have gotten a rash and hives about a week after the injection. I still have itching in periodic hive or two on the original on Period the new one now has a rashEnd it moves up to neck and face on the same side as the shot. Nothing dramatic.

Release 4 — day 14, dose 2

2021-02-26

Symptoms: I just still have a rash. Fatigue. Headache. Joint, bone, body aches.

Release 5 — day 21, dose 2

2021-03-05

Symptoms: Rash, new small itchy hives. Still on arms, small sores on face and jaw.

Release 5 — day 28, dose 2

2021-03-10

Symptoms: More hives Period itching Period a long shot area and other lymph node areas.

Release 5 — day 35, dose 2

2021-03-17

Symptoms: The rash and hives are getting worse on my arm neck and face Also the lymph nodes of my legs and armpits. This is just like the rash I got at the start. So I believe it is still from the vaccination Also I still have fatigue joint and bone eggs

Release 6 — day 42, dose 2

2021-03-24

Symptoms: Still have annoying itchy hives and rash along the same places as right after the shot.I feel that I still have the poison in me And it is not flushing out. Every now and then I get the same taste in my mouth that I had when I first got the injec.

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
SDArthralgia ✓ ✓ ✓
SDArthropathy ✓ ✓ ✓
SDBone disorder ✓ ✓ ✓
SDBone pain ✓ ✓ ✓
SDDysgeusia ✓ ✓ ✓
SDFatigue ✓ ✓ ✓
SDHeadache ✓ ✓ ✓
SDLymphadenopathy ✓ ✓ ✓
SDPain ✓ ✓ ✓
SDPruritus ✓ ✓ ✓
SDRash ✓ ✓ ✓
SDSkin lesion ✓ ✓ ✓
SDUrticaria ✓ ✓ ✓
SROEar discomfort ✓ ✓ ✓
SROEar pain ✓ ✓ ✓
SROEye irritation ✓ ✓ ✓
SROHeadache ✓ ✓ ✓
SROInjection site pruritus ✓ ✓ ✓
SROInjection site rash ✓ ✓ ✓
SROInjection site urticaria ✓ ✓ ✓
SROLymphadenopathy ✓ ✓ ✓
SROMuscle tightness ✓ ✓ ✓
SROPain in jaw ✓ ✓ ✓
SROPyrexia ✓ ✓ ✓
SRORash ✓ ✓ ✓
SROSelf-medication ✓ ✓ ✓
SROSensitive skin ✓ ✓ ✓
SROTenderness ✓ ✓ ✓

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