Y39-12734-86517

4 vaccinations 9 coded responses 56 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 56-60
ZIP prefix: 481 / MI
Registered: 2021-04-01

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

2021-04-01
Registered in v-safe
2021-04-01
Dose 1 — Moderna
2021-04-01
Survey response — day 0, dose 1
MedDRA: Paraesthesia — Feeling: Good · Site: Pain

Free text: Tingling from hips down to toes about 10 minutes after shot, it lasted about 40 minutes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Pain in extremity — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Free text: Severe arm pain about 29 hrs after injection

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

Adult check-in
2021-04-05
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-06
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-07
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-04-08
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-15
Survey response — day 14, dose 1
MedDRA: Back pain, Influenza like illness, Musculoskeletal pain — Feeling: Good

Free text: 4/12 - 4/13 back hurt just under my right shoulder blade and was not able to take a deep breathe without it hurting. However on 4/14 & beyond i feel great and have zero issues breathing normally. Maybe just a fluke.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-22
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-29
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-04-30
Dose 2 — Moderna
2021-04-30
Survey response — day 0, dose 2
MedDRA: Paraesthesia — Feeling: Good

Free text: 2nd vaccine, during 15 minute waiting period @ 3 minutes mark toes starting tingling again this moved to to just below my knees, lasted 15 minutes then started subsiding, after 22 minutes tingling was mid-foot to toes, @33 minutes tingling is still @ mid-foot to toes

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-01
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Fever · Diarrhea, Rash, not including the immediate area around the injection site

Adult check-in
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Diarrhea, Rash, not including the immediate area around the injection site

Adult check-in
2021-05-05
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Diarrhea, Rash, not including the immediate area around the injection site

Adult check-in
2021-05-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Swelling, Itching · Diarrhea, Rash, not including the immediate area around the injection site

Adult check-in
2021-05-08
Health check-in — day 7, dose 2
Feeling: Good · Diarrhea

Adult check-in
2021-05-14
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-21
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-28
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-05
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-11
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-01
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-29
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-12-24
Dose 3 — Moderna
2021-12-24
Health check-in — day 0, dose 3
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-12-25
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Headache, Fatigue or tiredness

Adult check-in
2021-12-26
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Swelling · Headache, Fatigue or tiredness

Adult check-in
2021-12-27
Survey response — days 1–6 daily, dose 3
MedDRA: Discomfort, Oedema peripheral — Feeling: Good · Site: Swelling, Itching · Headache, Diarrhea

Free text: Arm pit seems slightly swollen discomfort when applying deodorant

MedDRA releases: 2024-11 · check-in free text available
2021-12-28
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema peripheral — Feeling: Good · Site: Itching · Headache, Diarrhea

Free text: Arm pit is slightly swollen

MedDRA releases: 2024-11 · check-in free text available
2021-12-29
Survey response — days 1–6 daily, dose 3
MedDRA: Oedema peripheral — Feeling: Good

Free text: Arm pit is still slightly swollen

MedDRA releases: 2024-11 · check-in free text available
2021-12-30
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-12-31
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-01-08
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2022-01-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-01-21
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-01-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-04
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-03-25
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-06-27
Survey response — 6 months, dose 3
MedDRA: Chest discomfort, Oropharyngeal pain — Feeling: Fair

Free text: Sore throat, heavy chest

MedDRA releases: 2024-11 · check-in free text available
2022-12-23
Dose 4 — Moderna
2022-12-24
Health check-in — 12 months, dose 3
Feeling: Good

Adult check-in
2022-12-24
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-12-25
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness, Diarrhea

Adult check-in
2022-12-26
Survey response — days 1–6 daily, dose 4
MedDRA: Discomfort — Feeling: Good

Free text: Slight discomfort in the lower portion of left armpit, shot was in my left arm

MedDRA releases: 2024-11 · check-in free text available
2022-12-27
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Swelling · None

Adult check-in
2022-12-28
Health check-in — days 1–6 daily, dose 4
Feeling: Good · None

Adult check-in
2022-12-29
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Headache, Diarrhea

Adult check-in
2022-12-30
Health check-in — day 7, dose 4
Feeling: Good · Headache

Adult check-in
2023-01-06
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2023-01-13
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2023-01-20
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2023-01-27
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2023-02-03
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-03-24
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-06-24
Health check-in — 6 months, dose 4
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-01	Moderna
2	2021-04-30	Moderna
3	2021-12-24	Moderna	No
4	2022-12-23	Moderna	No

Free text

Release 6 — day 0, dose 1

2021-04-01

Systemic reaction (other): Tingling from hips down to toes about 10 minutes after shot, it lasted about 40 minutes

Release 6 — days 1–6 daily, dose 1

2021-04-03

Systemic reaction (other): Severe arm pain about 29 hrs after injection

Release 7 — day 14, dose 1

2021-04-15

Symptoms: 4/12 - 4/13 back hurt just under my right shoulder blade and was not able to take a deep breathe without it hurting. However on 4/14 & beyond i feel great and have zero issues breathing normally. Maybe just a fluke.

Release 8 — day 0, dose 2

2021-04-30

Systemic reaction (other): 2nd vaccine, during 15 minute waiting period @ 3 minutes mark toes starting tingling again this moved to to just below my knees, lasted 15 minutes then started subsiding, after 22 minutes tingling was mid-foot to toes, @33 minutes tingling is still @ mid-foot to toes

Release 10 — days 1–6 daily, dose 3

2021-12-27

Systemic reaction (other): Arm pit seems slightly swollen discomfort when applying deodorant

2021-12-28

Systemic reaction (other): Arm pit is slightly swollen

2021-12-29

Systemic reaction (other): Arm pit is still slightly swollen

Release 12 — 6 months, dose 3

2022-06-27

Symptoms: Sore throat, heavy chest

Release 12 — days 1–6 daily, dose 4

2022-12-26

Systemic reaction (other): Slight discomfort in the lower portion of left armpit, shot was in my left arm

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 pain	✓	✓	✓
SD	Chest discomfort	·	·	✓
SD	Influenza like illness	✓	✓	✓
SD	Musculoskeletal pain	✓	✓	✓
SD	Oropharyngeal pain	·	·	✓
SRO	Discomfort	·	·	✓
SRO	Oedema peripheral	·	·	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓

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