6Y6-22692-40122

4 vaccinations 9 coded responses 51 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 191 / PA
Registered: 2021-01-27

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

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-01-26
Dose 1 — Moderna
2021-01-27
Registered in v-safe
2021-01-27
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Swelling · Nausea

Adult check-in
2021-01-28
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling · None

Adult check-in
2021-01-29
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain, Redness, Swelling, Itching · None

Adult check-in
2021-01-30
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-01-31
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-01
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-02-02
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-02-09
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-02-16
Survey response — day 21, dose 1
MedDRA: Bone pain, Nausea, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities

Free text: Just started Fosamax 3 weeks ago- associated nausea and bone pain increasing with each dose.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-23
Dose 2 — Moderna
2021-02-23
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-02-24
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-25
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness · Fever · Headache, Joint pains, Muscle or body aches, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-02-26
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-27
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Redness, Itching · None

Adult check-in
2021-02-28
Survey response — days 1–6 daily, dose 2
MedDRA: Eczema, Pre-existing disease, Rash — Feeling: Good · Site: Redness, Itching · Rash, not including the immediate area around the injection site

Free text: Exacerbated rash with history of excema

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-01
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Itching · None

Adult check-in
2021-03-02
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-03-09
Survey response — day 14, dose 2
MedDRA: Pruritus — Feeling: Good

Free text: Exacerbated Itching hands, trunk and back. Using already prescribed topical steroids.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-16
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-23
Survey response — day 28, dose 2
MedDRA: Pruritus, Rash, Self-medication — Feeling: Good

Free text: Had pneumovax vaccine 3/15/2021 and had same onset of rash and itching of hands and trunk. Used topical steroids and Claritin. Never had vaccine reaction like this before 2 nd covid 19.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-04-06
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-25
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-24
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-10-06
Dose 3 — Moderna
2021-10-06
Survey response — day 0, dose 3
MedDRA: Dental implantation, Oral surgery — Feeling: Good

Free text: Had oral surgery and dental implants 10 days agocompleted antibiotics 5 days ago

MedDRA releases: 2024-11 · check-in free text available
2021-10-07
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

Adult check-in
2021-10-08
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-09
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-10-10
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection site

Adult check-in
2021-10-11
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Itching · None

Adult check-in
2021-10-12
Survey response — days 1–6 daily, dose 3
MedDRA: Colitis — Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Diarrhea

Free text: I believe symptoms from antibiotic induced colitis

MedDRA releases: 2024-11 · check-in free text available
2021-10-13
Health check-in — day 7, dose 3
Feeling: Fair · Fatigue or tiredness

Adult check-in
2021-10-20
Survey response — day 14, dose 3
MedDRA: Headache, Neck pain, Pre-existing disease — Feeling: Fair

Free text: Headache/ neck ache due to medrol pack for asthma

MedDRA releases: 2024-11 · check-in free text available
2021-10-29
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-03
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-10
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2021-11-17
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-01-05
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-04-02
Dose 4 — Moderna
2022-04-02
Health check-in — day 0, dose 4
Feeling: Fair · Site: Pain · Nausea

Adult check-in
2022-04-03
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2022-04-04
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea

Adult check-in
2022-04-06
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-07
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-04-08
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Abdominal pain

Adult check-in
2022-04-11
Health check-in — day 7, dose 4
Feeling: Good · None

Adult check-in
2022-04-16
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-04-23
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-04-30
Survey response — day 28, dose 4
MedDRA: Dermatitis, Rash — Feeling: Good

Free text: Dermatitis rash

MedDRA releases: 2024-11 · check-in free text available
2022-05-08
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-05-16
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2022-10-03
Survey response — 6 months, dose 4
MedDRA: Nasopharyngitis, Sinus disorder — Feeling: Fair

Free text: Sinus and cold symptoms

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-26	Moderna
2	2021-02-23	Moderna
3	2021-10-06	Moderna	No
4	2022-04-02	Moderna	No

Free text

Release 4 — day 21, dose 1

2021-02-16

Symptoms: Just started Fosamax 3 weeks ago- associated nausea and bone pain increasing with each dose.

Release 4 — days 1–6 daily, dose 2

2021-02-28

Systemic reaction (other): Exacerbated rash with history of excema

Release 5 — day 14, dose 2

2021-03-09

Symptoms: Exacerbated Itching hands, trunk and back. Using already prescribed topical steroids.

Release 6 — day 28, dose 2

2021-03-23

Symptoms: Had pneumovax vaccine 3/15/2021 and had same onset of rash and itching of hands and trunk. Used topical steroids and Claritin. Never had vaccine reaction like this before 2 nd covid 19.

Release 10 — day 0, dose 3

2021-10-06

Systemic reaction (other): Had oral surgery and dental implants 10 days agocompleted antibiotics 5 days ago

Release 10 — days 1–6 daily, dose 3

2021-10-12

Systemic reaction (other): I believe symptoms from antibiotic induced colitis

Release 10 — day 14, dose 3

2021-10-20

Symptoms: Headache/ neck ache due to medrol pack for asthma

Release 11 — day 28, dose 4

2022-04-30

Symptoms: Dermatitis rash

Release 12 — 6 months, dose 4

2022-10-03

Symptoms: Sinus and cold symptoms

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	Bone pain	✓	✓	✓
SD	Dermatitis	·	·	✓
SD	Headache	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Nausea	✓	✓	✓
SD	Neck pain	·	·	✓
SD	Pre-existing disease	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Self-medication	✓	✓	✓
SD	Sinus disorder	·	·	✓
SRO	Colitis	·	·	✓
SRO	Dental implantation	·	·	✓
SRO	Eczema	✓	✓	✓
SRO	Oral surgery	·	·	✓
SRO	Pre-existing disease	✓	✓	✓
SRO	Rash	✓	✓	✓

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