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5ZM-27268-57324

3 vaccinations 17 coded responses 36 check-ins 17 free-text entries 0 call cases
Sex
Female
Age at first dose
36-40
ZIP prefix
113 / NY
Registered
2021-01-22
Relationship
Self
Race
Other
Ethnicity
Hispanic or Latino
Registered dependents
V5C-21484-49923 Child or adolescent in my care · Male · 2021-11-09

Timeline

  1. 2021-01-20
    Dose 1 — Moderna
  2. 2021-01-22
    Registered in v-safe
  3. 2021-01-22
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site
    Adult check-in
  4. 2021-01-23
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Itching · Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  5. 2021-01-24
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  6. 2021-01-25
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness, Diarrhea
    Adult check-in
  7. 2021-01-26
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness, Diarrhea
    Adult check-in
  8. 2021-01-27
    Health check-in — day 7, dose 1
    Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness, Diarrhea
    Adult check-in
  9. 2021-02-03
    Survey response — day 14, dose 1
    MedDRA: Fatigue, Headache, Injection site rash, Rash erythematous, Rash pruritic, Skin warm — Feeling: Fair · Be unable to do your normal daily activities
    Free text: A week later I started to have a rash in the injection side, started like a small size but kept growing it look like a ring red and kind of yellow in the middle. It was very itchy and hot to the touch. Had headache for a few days & felt very tired.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-02-10
    Survey response — day 21, dose 1
    MedDRA: Dermatitis acneiform, Fatigue, Vaccination site discolouration, Vaccination site pruritus — Feeling: Fair
    Free text: Rash looks like acne bumps and is itching where the vaccine was injected. Also in the same place is like yellow and now is purple like a bruise ? Very faint colors but you can notice the difference, feeling tired too
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-02-17
    Survey response — day 28, dose 1
    MedDRA: Injection site rash — Feeling: Good
    Free text: Just the same rash on the injection side but much less this time
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-02-18
    Dose 2 — Moderna
  13. 2021-02-18
    Health check-in — day 0, dose 2
    Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness, Diarrhea
    Adult check-in
  14. 2021-02-19
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities
    Adult check-in
  15. 2021-02-20
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  16. 2021-02-21
    Survey response — days 1–6 daily, dose 2
    MedDRA: Arthralgia, Back pain — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities
    Free text: Back pain and on the shoulders since yesterday
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-02-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site
    Adult check-in
  18. 2021-02-24
    Survey response — days 1–6 daily, dose 2
    MedDRA: Back pain, Painful respiration — Feeling: Fair · Site: Itching · Muscle or body aches
    Free text: Back pain while breathing
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-02-25
    Survey response — day 7, dose 2
    MedDRA: Rash — Feeling: Fair · Site: Itching · Rash, not including the immediate area around the injection site
    Free text: Rash in the Other arm, and neck it comes and goes
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  20. 2021-03-04
    Health check-in — day 14, dose 2
    Feeling: Fair
    Adult check-in
  21. 2021-03-11
    Health check-in — day 21, dose 2
    Feeling: Fair
    Adult check-in
  22. 2021-03-18
    Survey response — day 28, dose 2
    MedDRA: Diarrhoea, Rash, Sneezing — Feeling: Fair
    Free text: Diarrhea, sneezing sometimes rash but not sure if related to the vaccine
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  23. 2021-03-25
    Survey response — day 35, dose 2
    MedDRA: Diarrhoea — Feeling: Good
    Free text: Diarrhea on and off
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  24. 2021-04-01
    Survey response — day 42, dose 2
    MedDRA: Sneezing — Feeling: Fair
    Free text: I been sneezing a lot not sure if is the change if season or what my nose gets too dry
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  25. 2021-05-22
    Survey response — 3 months, dose 2
    MedDRA: Cough, Headache, Sneezing — Feeling: Poor
    Free text: A lot of headaches not sure if related to the vaccine and sometimes coughing and sneezing but not sure if ls just allergy season
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  26. 2021-08-19
    Survey response — 6 months, dose 2
    MedDRA: Dizziness, Fatigue, Vaccine positive rechallenge — Feeling: Fair · Be unable to do your normal daily activities
    Free text: A lot fatigue some days like the reaction after the second doze of the vaccine. I dont know if is related to, but is not something I have had in the pass and is just a tiredness/fatigue/dizziness unexplainable! Very very weird could be the vaccin
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  27. 2021-11-30
    Dose 3 — Moderna
  28. 2021-11-30
    Health check-in — day 0, dose 3
    Feeling: Good · Site: Pain · None
    Adult check-in
  29. 2021-12-01
    Health check-in — days 1–6 daily, dose 3
    Feeling: Poor · Site: Pain, Itching · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  30. 2021-12-02
    Survey response — days 1–6 daily, dose 3
    MedDRA: Axillary pain, Injection site reaction, Pain, Tenderness — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: A weird pain in the underarm on the injection site still hurts a lot like is sore and it hurts while moving arm or touching
    MedDRA releases: 2024-11 · check-in free text available
  31. 2021-12-03
    Survey response — days 1–6 daily, dose 3
    MedDRA: Axillary pain — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activities
    Free text: A lot of pain since yesterday in the armpit where the shot was administered
    MedDRA releases: 2024-11 · check-in free text available
  32. 2021-12-04
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities
    Adult check-in
  33. 2021-12-05
    Survey response — days 1–6 daily, dose 3
    MedDRA: Axillary pain — Feeling: Good · Site: Pain, Swelling, Itching · Fatigue or tiredness, Diarrhea, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities
    Free text: Pain in my armpit where the injection arm
    MedDRA releases: 2024-11 · check-in free text available
  34. 2021-12-06
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness, Abdominal pain
    Adult check-in
  35. 2021-12-09
    Health check-in — day 7, dose 3
    Feeling: Fair · Site: Itching · None
    Adult check-in
  36. 2021-12-23
    Health check-in — day 21, dose 3
    Feeling: Fair
    Adult check-in
  37. 2021-12-28
    Survey response — day 28, dose 3
    MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Tiredness more than usual
    MedDRA releases: 2024-11 · check-in free text available
  38. 2022-01-06
    Survey response — day 35, dose 3
    MedDRA: Fatigue, Oropharyngeal pain — Feeling: Fair · Be unable to work or attend school
    Free text: Tiredness, sore throat
    MedDRA releases: 2024-11 · check-in free text available
  39. 2022-03-01
    Health check-in — 3 months, dose 3
    Feeling: Fair
    Adult check-in
  40. 2022-05-31
    Survey response — 6 months, dose 3
    MedDRA: COVID-19 — Feeling: Fair · Be unable to work or attend school
    Free text: Got Covid
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-01-20Moderna
22021-02-18Moderna
32021-11-30Moderna No

Free text

Release 3 — day 14, dose 1

2021-02-03

Symptoms: A week later I started to have a rash in the injection side, started like a small size but kept growing it look like a ring red and kind of yellow in the middle. It was very itchy and hot to the touch. Had headache for a few days & felt very tired. cut off by CDC

Release 4 — day 21, dose 1

2021-02-10

Symptoms: Rash looks like acne bumps and is itching where the vaccine was injected. Also in the same place is like yellow and now is purple like a bruise ? Very faint colors but you can notice the difference, feeling tired too

Release 4 — day 28, dose 1

2021-02-17

Symptoms: Just the same rash on the injection side but much less this time

Release 4 — days 1–6 daily, dose 2

2021-02-21

Systemic reaction (other): Back pain and on the shoulders since yesterday

2021-02-24

Systemic reaction (other): Back pain while breathing

Release 4 — day 7, dose 2

2021-02-25

Systemic reaction (other): Rash in the Other arm, and neck it comes and goes

Release 5 — day 28, dose 2

2021-03-18

Symptoms: Diarrhea, sneezing sometimes rash but not sure if related to the vaccine

Release 6 — day 35, dose 2

2021-03-25

Symptoms: Diarrhea on and off

Release 6 — day 42, dose 2

2021-04-01

Symptoms: I been sneezing a lot not sure if is the change if season or what my nose gets too dry

Release 8 — 3 months, dose 2

2021-05-22

Symptoms: A lot of headaches not sure if related to the vaccine and sometimes coughing and sneezing but not sure if ls just allergy season

Release 9 — 6 months, dose 2

2021-08-19

Symptoms: A lot fatigue some days like the reaction after the second doze of the vaccine. I dont know if is related to, but is not something I have had in the pass and is just a tiredness/fatigue/dizziness unexplainable! Very very weird could be the vaccin

Release 10 — days 1–6 daily, dose 3

2021-12-02

Systemic reaction (other): A weird pain in the underarm on the injection site still hurts a lot like is sore and it hurts while moving arm or touching

2021-12-03

Systemic reaction (other): A lot of pain since yesterday in the armpit where the shot was administered

2021-12-05

Systemic reaction (other): Pain in my armpit where the injection arm

Release 10 — day 28, dose 3

2021-12-28

Symptoms: Tiredness more than usual

Release 10 — day 35, dose 3

2022-01-06

Symptoms: Tiredness, sore throat

Release 11 — 6 months, dose 3

2022-05-31

Symptoms: Got Covid

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
SDCough ✓ ✓ ✓
SDCOVID-19 · · ✓
SDDermatitis acneiform ✓ ✓ ✓
SDDiarrhoea ✓ ✓ ✓
SDDizziness ✓ · ✓
SDFatigue ✓ ✓ ✓
SDHeadache ✓ ✓ ✓
SDInjection site rash ✓ ✓ ✓
SDOropharyngeal pain · · ✓
SDRash ✓ ✓ ✓
SDRash erythematous ✓ ✓ ✓
SDRash pruritic ✓ ✓ ✓
SDSkin warm ✓ ✓ ✓
SDSneezing ✓ ✓ ✓
SDVaccination site discolouration ✓ ✓ ✓
SDVaccination site pruritus ✓ ✓ ✓
SDVaccine positive rechallenge ✓ · ✓
SROArthralgia ✓ ✓ ✓
SROAxillary pain · · ✓
SROBack pain ✓ ✓ ✓
SROInjection site reaction · · ✓
SROPain · · ✓
SROPainful respiration ✓ ✓ ✓
SRORash ✓ ✓ ✓
SROTenderness · · ✓

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

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