YGX-21114-26142

4 vaccinations 9 coded responses 36 check-ins 9 free-text entries 0 call cases

Sex: Female
Age at first dose: 66+
ZIP prefix: 152 / PA
Registered: 2021-03-29

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

2021-02-25
Dose 1 — Moderna
2021-03-26
Dose 2 — Moderna
2021-03-29
Registered in v-safe
2021-03-29
Survey response — days 1–6 daily, dose 2
MedDRA: Unevaluable event — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Moderately severe symptoms 24-48 hrs post 2nd Moderna

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-03-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-03-31
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-01
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-04-02
Health check-in — day 7, dose 2
Feeling: Good · Site: Swelling, Itching · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-04-09
Survey response — day 14, dose 2
MedDRA: Rash, Rash pruritic — Feeling: Good

Free text: Small area of itchy rash under & posterior to arm used for injection. Present Thursday but gone today.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Survey response — day 21, dose 2
MedDRA: Injection site rash, Urticaria — Feeling: Good

Free text: Initially small hives, then changing to Itchy rash on opposite upper arm similar to rash I had near injection site.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-23
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-05-01
Survey response — day 35, dose 2
MedDRA: Parosmia — Feeling: Good

Free text: Phantoms is (cigarette smoke)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-07
Survey response — day 42, dose 2
MedDRA: Pruritus, Rash, Rash pruritic — Feeling: Good

Free text: Itchy rash inner aspect of opposite upper arm.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-27
Survey response — 3 months, dose 2
MedDRA: Flank pain — Feeling: Good · Be unable to do your normal daily activities

Free text: Right posterior flank pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-10-23
Dose 3 — Moderna
2021-10-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-26
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-10-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-10-28
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site

Adult check-in
2021-10-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain, Redness, Itching · Headache, Muscle or body aches, Rash, not including the immediate area around the injection site

Adult check-in
2021-10-30
Health check-in — day 7, dose 3
Feeling: Good · Site: Pain, Swelling, Itching · Headache, Muscle or body aches, Rash, not including the immediate area around the injection site

Adult check-in
2021-11-06
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-11-13
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-11-20
Health check-in — day 28, dose 3
Feeling: Good

Adult check-in
2021-11-27
Health check-in — day 35, dose 3
Feeling: Fair

Adult check-in
2021-12-04
Survey response — day 42, dose 3
MedDRA: Bursitis — Feeling: Good · Be unable to do your normal daily activities

Free text: Bursitis

MedDRA releases: 2024-11 · check-in free text available
2022-01-22
Survey response — 3 months, dose 3
MedDRA: Malaise, SARS-CoV-2 test negative — Feeling: Fair · Be unable to do your normal daily activities

Free text: COVID-19 symptoms 12/31/21-1/14/22 Test negative

MedDRA releases: 2024-11 · check-in free text available
2022-04-18
Dose 4 — Pfizer-BioNTech
2022-04-18
Health check-in — day 0, dose 4
Feeling: Good · None

Adult check-in
2022-04-19
Survey response — days 1–6 daily, dose 4
MedDRA: Flank pain — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Left flank pain

MedDRA releases: 2024-11 · check-in free text available
2022-04-20
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-21
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-22
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2022-04-23
Health check-in — days 1–6 daily, dose 4
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2022-04-24
Health check-in — days 1–6 daily, dose 4
Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness

Adult check-in
2022-04-25
Health check-in — day 7, dose 4
Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2022-05-02
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-05-09
Health check-in — day 21, dose 4
Feeling: Good

Adult check-in
2022-05-16
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-05-23
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-05-30
Health check-in — day 42, dose 4
Feeling: Fair

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-02-25	Moderna
2	2021-03-26	Moderna
3	2021-10-23	Moderna	No
4	2022-04-18	Pfizer-BioNTech	No

Free text

Release 6 — days 1–6 daily, dose 2

2021-03-29

Systemic reaction (other): Moderately severe symptoms 24-48 hrs post 2nd Moderna

Release 7 — day 14, dose 2

2021-04-09

Symptoms: Small area of itchy rash under & posterior to arm used for injection. Present Thursday but gone today.

Release 7 — day 21, dose 2

2021-04-16

Symptoms: Initially small hives, then changing to Itchy rash on opposite upper arm similar to rash I had near injection site.

Release 8 — day 35, dose 2

2021-05-01

Symptoms: Phantoms is (cigarette smoke)

Release 8 — day 42, dose 2

2021-05-07

Symptoms: Itchy rash inner aspect of opposite upper arm.

Release 9 — 3 months, dose 2

2021-06-27

Symptoms: Right posterior flank pain

Release 10 — day 42, dose 3

2021-12-04

Symptoms: Bursitis

Release 11 — 3 months, dose 3

2022-01-22

Symptoms: COVID-19 symptoms 12/31/21-1/14/22 Test negative

Release 11 — days 1–6 daily, dose 4

2022-04-19

Systemic reaction (other): Left flank pain

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	Bursitis	·	·	✓
SD	Flank pain	✓	✓	✓
SD	Injection site rash	✓	✓	✓
SD	Malaise	·	·	✓
SD	Parosmia	✓	✓	✓
SD	Pruritus	✓	✓	✓
SD	Rash	✓	✓	✓
SD	Rash pruritic	✓	✓	✓
SD	SARS-CoV-2 test negative	·	·	✓
SD	Urticaria	✓	✓	✓
SRO	Flank pain	·	·	✓
SRO	Unevaluable event	✓	✓	✓

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