Y3F-20774-93868

3 vaccinations 14 coded responses 39 check-ins 13 free-text entries 0 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 930 / CA
Registered: 2021-05-08

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

Registered dependents

Z45-12219-98522 Child or adolescent in my care · Male · 2022-01-13

VW9-22032-00796 Child or adolescent in my care · Female · 2022-01-13

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-05-07
Dose 1 — Moderna
2021-05-08
Registered in v-safe
2021-05-08
Survey response — days 1–6 daily, dose 1
MedDRA: Paraesthesia — Feeling: Fair · Site: Pain, Itching · Headache

Free text: Tingling in the face and neck area

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-05-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-05-11
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus congestion — Feeling: Fair

Free text: Sinus congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus congestion — Feeling: Good · Headache

Free text: Sinus congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-13
Survey response — days 1–6 daily, dose 1
MedDRA: Sinus congestion — Feeling: Good · Headache

Free text: Sinus congestions

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-14
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-05-21
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-28
Survey response — day 21, dose 1
MedDRA: Arthralgia — Feeling: Good

Free text: Joint pain, not sure if its except use related

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-04
Health check-in — day 28, dose 1
Feeling: Good

Adult check-in
2021-06-05
Dose 2 — Moderna
2021-06-06
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · Fatigue or tiredness

Adult check-in
2021-06-07
Survey response — days 1–6 daily, dose 2
MedDRA: Muscle spasms, Muscle twitching — Feeling: Fair · Site: Pain, Itching · Joint pains, Fatigue or tiredness

Free text: Muscle twitching/spasm in the arm at injection site

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-08
Survey response — days 1–6 daily, dose 2
MedDRA: Injection site reaction, Muscle spasms, Neck pain, Respiratory tract congestion — Feeling: Fair · Headache, Joint pains, Fatigue or tiredness

Free text: Still muscle spasms in arm at injection site, and pain in neck muscles. Congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-10
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-11
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-06-12
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-06-19
Survey response — day 14, dose 2
MedDRA: Injection site pain, Injection site reaction, Muscle spasms, Muscle twitching — Feeling: Good

Free text: Muscle spasm/ twitching in upper arm at the injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-07-03
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-07-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-07-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-09-04
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-12-04
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-01-14
Dose 3 — Moderna
2022-01-14
Health check-in — day 0, dose 3
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2022-01-15
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2022-01-16
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Discomfort, Oedema peripheral — Feeling: Fair · Site: Pain, Swelling · Be unable to do your normal daily activities

Free text: The pain and swelling is in the left armpit of the left arm (injected arm). Possible swollen lymph node there but it is painful and causing discomfort. Will contact drs office for concern.

MedDRA releases: 2024-11 · check-in free text available
2022-01-17
Survey response — days 1–6 daily, dose 3
MedDRA: Back pain, Oedema peripheral — Feeling: Fair · Site: Pain, Swelling · Fatigue or tiredness

Free text: The swelling in the underarm has moved and is a little harder than yesterday. If it continues, will go see dr. A little back pain in the left area as well.

MedDRA releases: 2024-11 · check-in free text available
2022-01-18
Survey response — days 1–6 daily, dose 3
MedDRA: Axillary pain, Oedema peripheral — Feeling: Good · Site: Pain, Swelling

Free text: Still pain and swelling in the armpit of the arm that was injected.

MedDRA releases: 2024-11 · check-in free text available
2022-01-19
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Headache

Adult check-in
2022-01-20
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2022-01-23
Health check-in — day 7, dose 3
Feeling: Good · None

Adult check-in
2022-01-28
Survey response — day 14, dose 3
MedDRA: Hypoaesthesia, Muscle twitching — Feeling: Fair

Free text: Arm gets a little numb feeling at night, muscle twitches.

MedDRA releases: 2024-11 · check-in free text available
2022-02-06
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2022-02-11
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-18
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-02-25
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-04-15
Survey response — 3 months, dose 3
MedDRA: Axillary pain, Muscle spasms, Oedema peripheral, Pain, Paraesthesia — Feeling: Good

Free text: Random muscle spasms/tingling in arm of injection site. Throbbing in armpit of injection armafter booster, same underarm swelled up.

MedDRA releases: 2024-11 · check-in free text available
2022-07-15
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2023-01-14
Survey response — 12 months, dose 3
MedDRA: Migraine — Feeling: Fair

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-05-07	Moderna
2	2021-06-05	Moderna
3	2022-01-14	Moderna	No

Free text

Release 8 — days 1–6 daily, dose 1

2021-05-08

Systemic reaction (other): Tingling in the face and neck area

2021-05-11

Systemic reaction (other): Sinus congestion

2021-05-12

Systemic reaction (other): Sinus congestion

2021-05-13

Systemic reaction (other): Sinus congestions

Release 8 — day 21, dose 1

2021-05-28

Symptoms: Joint pain, not sure if its except use related

Release 8 — days 1–6 daily, dose 2

2021-06-07

Systemic reaction (other): Muscle twitching/spasm in the arm at injection site

2021-06-08

Systemic reaction (other): Still muscle spasms in arm at injection site, and pain in neck muscles. Congestion

Release 9 — day 14, dose 2

2021-06-19

Symptoms: Muscle spasm/ twitching in upper arm at the injection site.

Release 10 — days 1–6 daily, dose 3

2022-01-16

Systemic reaction (other): The pain and swelling is in the left armpit of the left arm (injected arm). Possible swollen lymph node there but it is painful and causing discomfort. Will contact drs office for concern.

2022-01-17

Systemic reaction (other): The swelling in the underarm has moved and is a little harder than yesterday. If it continues, will go see dr. A little back pain in the left area as well.

2022-01-18

Systemic reaction (other): Still pain and swelling in the armpit of the arm that was injected.

Release 11 — day 14, dose 3

2022-01-28

Symptoms: Arm gets a little numb feeling at night, muscle twitches.

Release 11 — 3 months, dose 3

2022-04-15

Symptoms: Random muscle spasms/tingling in arm of injection site. Throbbing in armpit of injection armafter booster, same underarm swelled up.

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	Arthralgia	✓	✓	✓
SD	Axillary pain	·	·	✓
SD	Hypoaesthesia	·	·	✓
SD	Injection site pain	✓	✓	○
SD	Injection site reaction	✓	✓	✓
SD	Migraine	·	·	✓
SD	Muscle spasms	✓	✓	✓
SD	Muscle twitching	✓	✓	✓
SD	Oedema peripheral	·	·	✓
SD	Pain	·	·	✓
SD	Paraesthesia	·	·	✓
SRO	Axillary pain	·	·	✓
SRO	Back pain	·	·	✓
SRO	Discomfort	·	·	✓
SRO	Injection site reaction	✓	✓	✓
SRO	Muscle spasms	✓	✓	✓
SRO	Muscle twitching	✓	✓	✓
SRO	Neck pain	✓	✓	✓
SRO	Oedema peripheral	·	·	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Sinus congestion	✓	✓	✓

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