Y82-21957-93612

4 vaccinations 10 coded responses 41 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 51-55
ZIP prefix: 774 / TX
Registered: 2021-03-21

Relationship: Self
Race: White
Ethnicity: Hispanic or Latino

Registered dependents

UV3-10144-24380 Adult relative or friend · Male · 2022-10-07

Timeline Vaccinations Free text MedDRA terms

Timeline

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

2021-03-13
Dose 1 — Moderna
2021-03-21
Registered in v-safe
2021-03-21
Health check-in — day 7, dose 1
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-27
Health check-in — day 14, dose 1
Feeling: Fair

Adult check-in
2021-04-03
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-04-10
Dose 2 — Moderna
2021-04-10
Health check-in — day 0, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-11
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-13
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-14
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-15
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Adult check-in
2021-04-16
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-17
Health check-in — day 7, dose 2
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-04-24
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-01
Survey response — day 21, dose 2
MedDRA: Injection site paraesthesia, Vaccination site pain — Feeling: Fair

Free text: Sudden sharp pain & tingling at vaccine site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-08
Survey response — day 28, dose 2
MedDRA: Fatigue, Injection site pain, Paraesthesia, Somnolence — Feeling: Fair

Free text: Sharp tingly pain at injection site, tingly hand. Tired & sleepy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Survey response — day 35, dose 2
MedDRA: Fatigue — Feeling: Fair · Be unable to do your normal daily activities

Free text: I am very tired daily.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-22
Survey response — day 42, dose 2
MedDRA: Asthenia, Fatigue, Somnolence — Feeling: Fair

Free text: Always tired and sleepy by end of day. No energy.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-07-10
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-10-09
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-19
Dose 3 — Moderna
2021-11-20
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-21
Survey response — days 1–6 daily, dose 3
MedDRA: Back pain, Paraesthesia, Peripheral swelling, Unevaluable event — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Left side of neck and back pain (injection in left arm). Entire arm feels swollen and tingles.

MedDRA releases: 2024-11 · check-in free text available
2021-11-22
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Neck pain — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activities

Free text: Neck and shoulder pain left side of body (injection was on left arm).

MedDRA releases: 2024-11 · check-in free text available
2021-11-23
Survey response — days 1–6 daily, dose 3
MedDRA: Arthralgia, Back pain, Neck pain — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Neck/shoulder/back pain on left side (injection on left arm).

MedDRA releases: 2024-11 · check-in free text available
2021-11-24
Health check-in — days 1–6 daily, dose 3
Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-11-25
Survey response — days 1–6 daily, dose 3
MedDRA: Headache, Pain — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Headache pain is horrible.

MedDRA releases: 2024-11 · check-in free text available
2021-11-26
Survey response — day 7, dose 3
MedDRA: Headache — Feeling: Poor · Site: Pain, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Headache daily.

MedDRA releases: 2024-11 · check-in free text available
2021-12-03
Health check-in — day 14, dose 3
Feeling: Fair

Adult check-in
2021-12-10
Health check-in — day 21, dose 3
Feeling: Fair

Adult check-in
2021-12-17
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-24
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-31
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-18
Health check-in — 3 months, dose 3
Feeling: Fair

Adult check-in
2022-05-21
Health check-in — 6 months, dose 3
Feeling: Fair

Adult check-in
2022-10-03
Dose 4 — Moderna
Co-administered: Flu
2022-10-07
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-10-09
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-10
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-10-21
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-10-24
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-10-31
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-11-07
Health check-in — day 35, dose 4
Feeling: Fair

Adult check-in
2022-11-16
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in
2023-01-02
Survey response — 3 months, dose 4
MedDRA: Headache, Oral mucosal blistering, Oropharyngeal pain, Respiratory tract congestion, Sinusitis — Feeling: Good · Be unable to work or attend school

MedDRA releases: 2024-11

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-13	Moderna
2	2021-04-10	Moderna
3	2021-11-19	Moderna	No
4	2022-10-03	Moderna	Flu

Free text

Release 8 — day 21, dose 2

2021-05-01

Symptoms: Sudden sharp pain & tingling at vaccine site.

Release 8 — day 28, dose 2

2021-05-08

Symptoms: Sharp tingly pain at injection site, tingly hand. Tired & sleepy.

Release 8 — day 35, dose 2

2021-05-15

Symptoms: I am very tired daily.

Release 8 — day 42, dose 2

2021-05-22

Symptoms: Always tired and sleepy by end of day. No energy.

Release 10 — days 1–6 daily, dose 3

2021-11-21

Systemic reaction (other): Left side of neck and back pain (injection in left arm). Entire arm feels swollen and tingles.

2021-11-22

Systemic reaction (other): Neck and shoulder pain left side of body (injection was on left arm).

2021-11-23

Systemic reaction (other): Neck/shoulder/back pain on left side (injection on left arm).

2021-11-25

Systemic reaction (other): Headache pain is horrible.

Release 10 — day 7, dose 3

2021-11-26

Systemic reaction (other): Headache daily.

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	Asthenia	✓	✓	✓
SD	Fatigue	✓	✓	✓
SD	Headache	·	·	✓
SD	Injection site pain	✓	✓	✓
SD	Injection site paraesthesia	✓	✓	✓
SD	Oral mucosal blistering	·	·	✓
SD	Oropharyngeal pain	·	·	✓
SD	Paraesthesia	✓	✓	✓
SD	Respiratory tract congestion	·	·	✓
SD	Sinusitis	·	·	✓
SD	Somnolence	✓	✓	✓
SD	Vaccination site pain	✓	✓	✓
SRO	Arthralgia	·	·	✓
SRO	Back pain	·	·	✓
SRO	Headache	·	·	✓
SRO	Neck pain	·	·	✓
SRO	Pain	·	·	✓
SRO	Paraesthesia	·	·	✓
SRO	Peripheral swelling	·	·	✓
SRO	Unevaluable event	·	·	✓

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