Y5P-15173-66046

4 vaccinations 10 coded responses 40 check-ins 10 free-text entries 0 call cases

Sex: Female
Age at first dose: 41-45
ZIP prefix: 301 / GA
Registered: 2021-03-09

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

Registered dependents

69D-30061-98514 Child or adolescent in my care · Male · 2021-11-10

8DV-17785-58748 Child or adolescent in my care · Female · 2021-11-10

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-03-08
Dose 1 — Moderna
2021-03-09
Registered in v-safe
2021-03-09
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

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

Adult check-in
2021-03-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-03-15
Health check-in — day 7, dose 1
Feeling: Good · Fatigue or tiredness

Adult check-in
2021-03-22
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-03-29
Health check-in — day 21, dose 1
Feeling: Good

Adult check-in
2021-04-05
Dose 2 — Moderna
2021-04-05
Health check-in — day 0, dose 2
Feeling: Good · None

Adult check-in
2021-04-06
Survey response — days 1–6 daily, dose 2
MedDRA: Headache — Feeling: Good · Site: Pain · Headache, Diarrhea

Free text: Headache was during the night only

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea

Adult check-in
2021-04-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Headache, Fatigue or tiredness

Adult check-in
2021-04-09
Survey response — days 1–6 daily, dose 2
MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · Site: Pain, Redness · Muscle or body aches, Fatigue or tiredness

Free text: Sore throat and congestion

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-10
Survey response — days 1–6 daily, dose 2
MedDRA: Nasopharyngitis, Sinus congestion — Feeling: Fair · Site: Pain · Fatigue or tiredness

Free text: Head cold, sinus congestion.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-11
Survey response — days 1–6 daily, dose 2
MedDRA: Cough, Respiratory tract congestion, Sinus congestion — Feeling: Fair · Fatigue or tiredness

Free text: Sinus and chest Congestion. Cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — day 7, dose 2
MedDRA: Cough, Respiratory tract congestion, Sinus congestion — Feeling: Fair

Free text: Chest congestion. Sinus congestion. Cough.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-19
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-04-26
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-05-04
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-10
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-05-17
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-07-05
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-04
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-09
Dose 3 — Moderna
2021-11-11
Survey response — days 1–6 daily, dose 3
MedDRA: Injection site discolouration — Feeling: Good · Site: Pain, Swelling · Nausea

Free text: I've noticed my arm where I've had all my covid shots is purple with white blotches. Not sure if it's related.

MedDRA releases: 2024-11 · check-in free text available
2021-11-12
Survey response — days 1–6 daily, dose 3
MedDRA: Rash macular, Skin discolouration — Feeling: Good · Site: Pain

Free text: Purple skin with white blotches on arm shot was administered.

MedDRA releases: 2024-11 · check-in free text available
2021-11-13
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-14
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · None

Adult check-in
2021-11-15
Health check-in — days 1–6 daily, dose 3
Feeling: Good · None

Adult check-in
2021-11-16
Survey response — day 7, dose 3
MedDRA: Reaction to previous exposure to any vaccine — Feeling: Good

Free text: Upper arm where injection was is purple with white blotches. Since first injection

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-02
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-07
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2022-02-08
Survey response — 3 months, dose 3
MedDRA: Fatigue, Oropharyngeal pain, Pain, Sinus congestion — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities

Free text: Sore throat. Sinus congestion. Fatigue. Body aches.

MedDRA releases: 2024-11 · check-in free text available
2022-05-10
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-11-30
Dose 4 — Moderna
Co-administered: Flu
2022-12-10
Health check-in — day 7, dose 4
Feeling: Good · Joint pains

Adult check-in
2022-12-14
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-12-21
Survey response — day 21, dose 4
MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: Poor

Free text: Congestion. Sore throat.

MedDRA releases: 2024-11 · check-in free text available
2022-12-30
Health check-in — day 28, dose 4
Feeling: Fair

Adult check-in
2023-01-04
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2023-01-11
Health check-in — day 42, dose 4
Feeling: Good

Adult check-in
2023-03-01
Health check-in — 3 months, dose 4
Feeling: Good

Adult check-in
2023-05-31
Health check-in — 6 months, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-08	Moderna
2	2021-04-05	Moderna
3	2021-11-09	Moderna	No
4	2022-11-30	Moderna	Flu

Free text

Release 7 — days 1–6 daily, dose 2

2021-04-06

Systemic reaction (other): Headache was during the night only

2021-04-09

Systemic reaction (other): Sore throat and congestion

2021-04-10

Systemic reaction (other): Head cold, sinus congestion.

2021-04-11

Systemic reaction (other): Sinus and chest Congestion. Cough.

Release 7 — day 7, dose 2

2021-04-14

Systemic reaction (other): Chest congestion. Sinus congestion. Cough.

Release 10 — days 1–6 daily, dose 3

2021-11-11

Systemic reaction (other): I've noticed my arm where I've had all my covid shots is purple with white blotches. Not sure if it's related.

2021-11-12

Systemic reaction (other): Purple skin with white blotches on arm shot was administered.

Release 10 — day 7, dose 3

2021-11-16

Systemic reaction (other): Upper arm where injection was is purple with white blotches. Since first injection

Release 11 — 3 months, dose 3

2022-02-08

Symptoms: Sore throat. Sinus congestion. Fatigue. Body aches.

Release 12 — day 21, dose 4

2022-12-21

Symptoms: Congestion. Sore throat.

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	Fatigue	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Pain	·	·	✓
SD	Respiratory tract congestion	·	·	✓
SD	Sinus congestion	·	·	✓
SRO	Cough	✓	✓	✓
SRO	Headache	✓	✓	✓
SRO	Injection site discolouration	·	·	✓
SRO	Nasopharyngitis	✓	✓	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Rash macular	·	·	✓
SRO	Reaction to previous exposure to any vaccine	·	·	✓
SRO	Respiratory tract congestion	✓	✓	✓
SRO	Sinus congestion	✓	✓	✓
SRO	Skin discolouration	·	·	✓

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