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YL9-14205-01317

2 vaccinations 6 coded responses 21 check-ins 6 free-text entries 0 call cases
Sex
Female
Age at first dose
41-45
ZIP prefix
902 / CA
Registered
2021-01-17
Relationship
Self
Race
Native Hawaiian or other Pacific Islander
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-16
    Dose 1 — Moderna
  2. 2021-01-17
    Registered in v-safe
  3. 2021-01-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · Fatigue or tiredness
    Adult check-in
  4. 2021-01-18
    Survey response — days 1–6 daily, dose 1
    MedDRA: Fatigue — Feeling: Fair · Site: Pain · Fatigue or tiredness
    Free text: Fatigue but not sure its from the vax
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-01-19
    Survey response — days 1–6 daily, dose 1
    MedDRA: Epistaxis — Feeling: Fair · Site: Itching · Fatigue or tiredness
    Free text: Bloody nose but I dont think its related but wanted to add this in case. I also live in (b)(6), CA and has been hot.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-21
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Joint pains, Fatigue or tiredness
    Adult check-in
  7. 2021-01-22
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-01-23
    Health check-in — day 7, dose 1
    Feeling: Fair · Site: Pain, Itching · None
    Adult check-in
  9. 2021-01-30
    Survey response — day 14, dose 1
    MedDRA: Arthralgia, Injection site inflammation, Injection site pruritus, Injection site rash, Myalgia — Feeling: Fair
    Free text: Rash a few inches below infection site. Started day 10 and was itching, inflamed and its better now but it still is itchy at times. The rash is slightly there. Joint and muscle pain on that arm as well.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-02-06
    Health check-in — day 21, dose 1
    Feeling: Fair
    Adult check-in
  11. 2021-02-10
    Dose 2 — Moderna
  12. 2021-02-13
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Redness, Itching · None
    Adult check-in
  13. 2021-02-14
    Survey response — days 1–6 daily, dose 2
    MedDRA: Anxiety — Feeling: Fair · Site: Itching · Headache, Muscle or body aches
    Free text: Anxiety (I have history of anxiety)
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-02-15
    Survey response — days 1–6 daily, dose 2
    MedDRA: Headache — Feeling: Good · Headache, Joint pains, Muscle or body aches
    Free text: Not sure if any of this is vaccine related. The twinge of headaches may be.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-02-16
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Fatigue or tiredness
    Adult check-in
  16. 2021-02-17
    Health check-in — day 7, dose 2
    Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  17. 2021-02-24
    Survey response — day 14, dose 2
    MedDRA: Dry skin, Eczema, Pruritus, Rash — Feeling: Good
    Free text: Itchy dry eczema like rash on both hands (knuckle region and beyond)
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-03-04
    Health check-in — day 21, dose 2
    Feeling: Fair
    Adult check-in
  19. 2021-03-10
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-03-17
    Health check-in — day 35, dose 2
    Feeling: Fair
    Adult check-in
  21. 2021-03-25
    Health check-in — day 42, dose 2
    Feeling: Fair
    Adult check-in
  22. 2021-05-13
    Health check-in — 3 months, dose 2
    Feeling: Fair
    Adult check-in
  23. 2021-08-11
    Health check-in — 6 months, dose 2
    Feeling: Fair
    Adult check-in
  24. 2022-02-10
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-16Moderna
22021-02-10Moderna

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-18

Systemic reaction (other): Fatigue but not sure its from the vax

2021-01-19

Systemic reaction (other): Bloody nose but I dont think its related but wanted to add this in case. I also live in (b)(6), CA and has been hot.
redacted (b)(6)

Release 3 — day 14, dose 1

2021-01-30

Symptoms: Rash a few inches below infection site. Started day 10 and was itching, inflamed and its better now but it still is itchy at times. The rash is slightly there. Joint and muscle pain on that arm as well.

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Anxiety (I have history of anxiety)

2021-02-15

Systemic reaction (other): Not sure if any of this is vaccine related. The twinge of headaches may be.

Release 4 — day 14, dose 2

2021-02-24

Symptoms: Itchy dry eczema like rash on both hands (knuckle region and beyond)

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

FieldPreferred term2021-092023-042024-11
SDArthralgia ✓ ✓ ✓
SDDry skin ✓ ✓ ✓
SDEczema ✓ ✓ ✓
SDInjection site inflammation ✓ ✓ ✓
SDInjection site pruritus ✓ ✓ ✓
SDInjection site rash ✓ ✓ ✓
SDMyalgia ✓ ✓ ✓
SDPruritus ✓ ✓ ✓
SDRash ✓ ✓ ✓
SROAnxiety ✓ ✓ ✓
SROEpistaxis ✓ ✓ ✓
SROFatigue ✓ ✓ ✓
SROHeadache ✓ ✓ ✓

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

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