636-10574-76802

3 vaccinations 10 coded responses 27 check-ins 10 free-text entries 2 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 150 / PA
Registered: 2021-03-07

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

2021-02-04
Dose 1 — Moderna
2021-03-04
Dose 2 — Moderna
2021-03-07
Registered in v-safe
2021-03-07
Survey response — days 1–6 daily, dose 2
MedDRA: Adverse reaction — Feeling: Good · Site: Pain · Be unable to do your normal daily activities

Free text: I had definite unpleasant symptoms day of vaccine administration, the Friday and early Saturday AFTER #2 and on days 9-12 with the #1 vaccine which I would like to discuss if possible

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-08
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Fatigue or tiredness

Adult check-in
2021-03-09
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-03-11
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-18
Survey response — day 14, dose 2
MedDRA: Discomfort, Pain — Feeling: Fair

Free text: Started having discomfort in my right clavicle and immediate surrounding area with movement and stretching. Received my #2 in my right arm

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-04-01
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-04-08
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-15
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-06-03
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-09-02
Survey response — 6 months, dose 2
MedDRA: Diarrhoea, Feeling abnormal — Feeling: Poor · Be unable to do your normal daily activities

Free text: Past 4days feeling poorly and having diarrhea. Not able to associate it with any food eaten. No fever or respiratory symptoms

MedDRA releases: 2021-09,2024-11 · check-in free text available
2021-10-27
Dose 3 — Moderna
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-10-29
Survey response — days 1–6 daily, dose 3
MedDRA: Peripheral coldness — Feeling: Poor · Site: Redness · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Free text: Both my hands yesterday were ice cold, now ok. My husband who got shot at same time had experienced weird cold hands

MedDRA releases: 2024-11 · check-in free text available
2021-10-30
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-31
Survey response — days 1–6 daily, dose 3
MedDRA: No adverse event — Feeling: Good · Site: Redness

Free text: Not that I'm conscious of

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Redness · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-02
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Joint pains, Fatigue or tiredness

Adult check-in
2021-11-03
Survey response — day 7, dose 3
MedDRA: Neck pain, Pain in jaw, Toothache — Feeling: Fair · Joint pains

Free text: Jaw and TEETH pain past 24 hrs down into my left neck area possibly glands

MedDRA releases: 2024-11 · check-in free text available
2021-11-11
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-17
Survey response — day 21, dose 3
MedDRA: Pre-existing disease, Pruritus — Feeling: Fair

Free text: Itchy ALL OVER MY BODY without an obvious rash or likely reason for this complaint..previously had and still continue with discomfort with teeth and upper jaw

MedDRA releases: 2024-11 · check-in free text available
2021-11-24
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-01
Survey response — day 35, dose 3
MedDRA: Ear pruritus, Pruritus — Feeling: Fair

Free text: Not sure if reported last week, but experiencing intensely itchy skin without rash or redness all over body including face and ears

MedDRA releases: 2024-11 · check-in free text available
2021-12-08
Health check-in — day 42, dose 3
Feeling: Fair

Adult check-in
2022-01-26
Survey response — 3 months, dose 3
MedDRA: Pruritus, Rash, Rash erythematous, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional

Free text: Symptoms: Itchy over upper body with obvious red rash on neck · Healthcare visit (other): Have appointment with dermatologist that I couldn't get scheduled until tomorrow

MedDRA releases: 2024-11 · check-in free text available
2022-01-26
Report sent to call center — 3 months, dose 3
Get care from a doctor or other healthcare professional

1 call case(s)
2022-03-31
Call 1 — Left Voicemail
2022-04-29
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-10-27
Survey response — 12 months, dose 3
MedDRA: COVID-19, Malaise, Medical counselling — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional

Free text: Symptoms: Had Covid 9/6/22. And VERY SICK not requiring hospitalization · Healthcare visit (other): Notified PCP who ordered the Pavlovix

MedDRA releases: 2024-11 · check-in free text available
2022-10-27
Report sent to call center — 12 months, dose 3
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

1 call case(s)
2022-10-28
Call 2 — Left Voicemail
2022-10-28
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-04	Moderna
2	2021-03-04	Moderna
3	2021-10-27	Moderna	No

Call center

2 call center cases

2 unsuccessful

See the call center timeline

Free text

Release 5 — days 1–6 daily, dose 2

2021-03-07

Systemic reaction (other): I had definite unpleasant symptoms day of vaccine administration, the Friday and early Saturday AFTER #2 and on days 9-12 with the #1 vaccine which I would like to discuss if possible

Release 5 — day 14, dose 2

2021-03-18

Symptoms: Started having discomfort in my right clavicle and immediate surrounding area with movement and stretching. Received my #2 in my right arm

Release 9 — 6 months, dose 2

2021-09-02

Symptoms: Past 4days feeling poorly and having diarrhea. Not able to associate it with any food eaten. No fever or respiratory symptoms

Release 10 — days 1–6 daily, dose 3

2021-10-29

Systemic reaction (other): Both my hands yesterday were ice cold, now ok. My husband who got shot at same time had experienced weird cold hands

2021-10-31

Systemic reaction (other): Not that I'm conscious of

Release 10 — day 7, dose 3

2021-11-03

Systemic reaction (other): Jaw and TEETH pain past 24 hrs down into my left neck area possibly glands

Release 10 — day 21, dose 3

2021-11-17

Symptoms: Itchy ALL OVER MY BODY without an obvious rash or likely reason for this complaint..previously had and still continue with discomfort with teeth and upper jaw

Release 10 — day 35, dose 3

2021-12-01

Symptoms: Not sure if reported last week, but experiencing intensely itchy skin without rash or redness all over body including face and ears

Release 11 — 3 months, dose 3

2022-01-26

Symptoms: Itchy over upper body with obvious red rash on neck

Healthcare visit (other): Have appointment with dermatologist that I couldn't get scheduled until tomorrow

Release 12 — 12 months, dose 3

2022-10-27

Symptoms: Had Covid 9/6/22. And VERY SICK not requiring hospitalization

Healthcare visit (other): Notified PCP who ordered the Pavlovix

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	Medical counselling	·	·	✓
HCVO	Unevaluable event	·	·	✓
SD	COVID-19	·	·	✓
SD	Diarrhoea	✓	·	✓
SD	Discomfort	✓	✓	✓
SD	Ear pruritus	·	·	✓
SD	Feeling abnormal	✓	·	✓
SD	Malaise	·	·	✓
SD	Pain	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SD	Pruritus	·	·	✓
SD	Rash	·	·	✓
SD	Rash erythematous	·	·	✓
SRO	Adverse reaction	✓	✓	✓
SRO	Neck pain	·	·	✓
SRO	No adverse event	·	·	✓
SRO	Pain in jaw	·	·	✓
SRO	Peripheral coldness	·	·	✓
SRO	Toothache	·	·	✓

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