Y2S-30469-25399

4 vaccinations 11 coded responses 22 check-ins 11 free-text entries 0 call cases

Sex: —
Age at first dose: 26-30
ZIP prefix: 946 / CA
Registered: 2021-12-23

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

2021-04-16
Dose 1 — Moderna
2021-05-14
Dose 2 — Moderna
2021-12-22
Dose 3 — Moderna
2021-12-23
Registered in v-safe
2021-12-23
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Adult check-in
2021-12-24
Survey response — days 1–6 daily, dose 3
MedDRA: Cough, Oedema peripheral, Tenderness — Feeling: Good · Site: Pain, Swelling · Chills

Free text: My armpit on the same side that I got the shot is tender and swollen. Also I was coughing yesterday.

MedDRA releases: 2024-11 · check-in free text available
2021-12-26
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Oedema peripheral — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: My armpit on the same side as the injection is still a little swollen, but the swelling is finally going down and it doesn't hurt anymore

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Oedema peripheral — Feeling: Good · Fatigue or tiredness · Be unable to work or attend school

Free text: Slight swelling in the armpit on the same side as the injection, doesn't hurt anymore and seems almost back to normal.

MedDRA releases: 2024-11 · check-in free text available
2021-12-29
Survey response — day 7, dose 3
MedDRA: Oedema peripheral — Feeling: Good · Fatigue or tiredness

Free text: Minor swelling in armpit same side as shot administered

MedDRA releases: 2024-11 · check-in free text available
2022-01-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-19
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-26
Survey response — day 35, dose 3
MedDRA: Headache — Feeling: Good

Free text: Mild headache for three days

MedDRA releases: 2024-11 · check-in free text available
2022-02-02
Survey response — day 42, dose 3
MedDRA: Cough, Fatigue, Sneezing — Feeling: Good

Free text: Coughing and sneezing and fatigue

MedDRA releases: 2024-11 · check-in free text available
2022-03-24
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-22
Survey response — 6 months, dose 3
MedDRA: Brain fog, Cough, Fatigue, Oropharyngeal pain, Pain, Respiratory tract congestion, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: I got a sore throat on 5/31/22 followed by aches and pains that night, tested positive for Covid on a rapid test 6/1, had a bad cough, exhaustion, brain fog, and congestion. Tested negative on a rapid test 6/12. Still coughing and fatigued now.

MedDRA releases: 2024-11 · check-in free text available
2022-10-12
Dose 4 — Moderna
2022-10-12
Survey response — day 0, dose 4
MedDRA: Brain fog — Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tiredness

Free text: Brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-10-13
Survey response — days 1–6 daily, dose 4
MedDRA: Brain fog — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Brain fog

MedDRA releases: 2024-11 · check-in free text available
2022-10-15
Survey response — days 1–6 daily, dose 4
MedDRA: Tenderness — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Still felt a little tenderness in the armpit on the same side as I got the shot

MedDRA releases: 2024-11 · check-in free text available
2022-10-16
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-10-17
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-19
Health check-in — day 7, dose 4
Feeling: Good · Fatigue or tiredness

Adult check-in
2022-10-26
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-02
Survey response — day 21, dose 4
MedDRA: Back injury — Feeling: Good · Be unable to work or attend school

Free text: Minor back injury

MedDRA releases: 2024-11 · check-in free text available
2022-11-09
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-16
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-11-23
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-16	Moderna	No
2	2021-05-14	Moderna	No
3	2021-12-22	Moderna	No
4	2022-10-12	Moderna	No

Free text

Release 10 — days 1–6 daily, dose 3

2021-12-24

Systemic reaction (other): My armpit on the same side that I got the shot is tender and swollen. Also I was coughing yesterday.

2021-12-26

Systemic reaction (other): My armpit on the same side as the injection is still a little swollen, but the swelling is finally going down and it doesn't hurt anymore

2021-12-28

Systemic reaction (other): Slight swelling in the armpit on the same side as the injection, doesn't hurt anymore and seems almost back to normal.

Release 10 — day 7, dose 3

2021-12-29

Systemic reaction (other): Minor swelling in armpit same side as shot administered

Release 11 — day 35, dose 3

2022-01-26

Symptoms: Mild headache for three days

Release 11 — day 42, dose 3

2022-02-02

Symptoms: Coughing and sneezing and fatigue

Release 12 — 6 months, dose 3

2022-06-22

Symptoms: I got a sore throat on 5/31/22 followed by aches and pains that night, tested positive for Covid on a rapid test 6/1, had a bad cough, exhaustion, brain fog, and congestion. Tested negative on a rapid test 6/12. Still coughing and fatigued now.

Release 12 — day 0, dose 4

2022-10-12

Systemic reaction (other): Brain fog

Release 12 — days 1–6 daily, dose 4

2022-10-13

Systemic reaction (other): Brain fog

2022-10-15

Systemic reaction (other): Still felt a little tenderness in the armpit on the same side as I got the shot

Release 12 — day 21, dose 4

2022-11-02

Symptoms: Minor back injury

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	Back injury	·	·	✓
SD	Brain fog	·	·	✓
SD	Cough	·	·	✓
SD	Fatigue	·	·	✓
SD	Headache	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	SARS-CoV-2 test positive	·	·	✓
SD	Sneezing	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Brain fog	·	·	✓
SRO	Cough	·	·	✓
SRO	Oedema peripheral	·	·	✓
SRO	Tenderness	·	·	✓

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