YSM-11910-05152

2 vaccinations 9 coded responses 26 check-ins 9 free-text entries 0 call cases

Sex: Male
Age at first dose: 41-45
ZIP prefix: 982 / WA
Registered: 2021-04-12

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

2021-04-12
Registered in v-safe
2021-04-12
Dose 1 — Moderna
2021-04-12
Survey response — day 0, dose 1
MedDRA: Paraesthesia, Pruritus — Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Pins and needles feeling down left arm where shot was put in shoulder. Tingling in hands. Itching on arms and legs.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-13
Survey response — days 1–6 daily, dose 1
MedDRA: Dry mouth, Feeling cold, Feeling hot, Feeling of body temperature change, Thirst — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Cotton mouth (thirsty); feeling hot & cold with no fever

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-15
Survey response — days 1–6 daily, dose 1
MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Sore throat

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-16
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-17
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-18
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · None

Adult check-in
2021-04-19
Health check-in — day 7, dose 1
Feeling: Good · None

Adult check-in
2021-04-26
Health check-in — day 14, dose 1
Feeling: Good

Adult check-in
2021-05-03
Survey response — day 21, dose 1
MedDRA: Abdominal pain, Diarrhoea, Flatulence, Gastrointestinal disorder, Increased upper airway secretion, Insomnia — Feeling: Fair

Free text: Gastrointestinal issues (diarrhea, gas, abdominal cramping), significant phlegm in throat, difficulty sleeping.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-10
Dose 2 — Moderna
2021-05-10
Survey response — day 0, dose 2
MedDRA: Dry mouth, Paraesthesia — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea, Abdominal pain

Free text: Tingling in fingers and feet and cotton mouth for first 90-120 minutes after 2nd shot

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-11
Survey response — days 1–6 daily, dose 2
MedDRA: Dry mouth — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities

Free text: Itching feet and ankles; cotton mouth

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-12
Health check-in — days 1–6 daily, dose 2
Feeling: Poor · Site: Pain · 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
2021-05-13
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-05-14
Survey response — days 1–6 daily, dose 2
MedDRA: Pruritus — Feeling: Good · Site: Pain · Fatigue or tiredness

Free text: Itching ankles & feet (only since shot)

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-05-15
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain, Itching · None

Adult check-in
2021-05-16
Health check-in — days 1–6 daily, dose 2
Feeling: Good · None

Adult check-in
2021-05-17
Health check-in — day 7, dose 2
Feeling: Good · None

Adult check-in
2021-05-24
Health check-in — day 14, dose 2
Feeling: Good

Adult check-in
2021-05-31
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-06-07
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-06-14
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-06-21
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-08-09
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-11-10
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2022-05-10
Survey response — 12 months, dose 2
MedDRA: Cough, Headache, Malaise, Myalgia — Feeling: Good

Free text: COVID like symptoms: muscle aches, coughing, headache

MedDRA releases: 2024-11 · check-in free text available

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-04-12	Moderna
2	2021-05-10	Moderna

Free text

Release 7 — day 0, dose 1

2021-04-12

Systemic reaction (other): Pins and needles feeling down left arm where shot was put in shoulder. Tingling in hands. Itching on arms and legs.

Release 7 — days 1–6 daily, dose 1

2021-04-13

Systemic reaction (other): Cotton mouth (thirsty); feeling hot & cold with no fever

2021-04-14

Systemic reaction (other): Sore throat

2021-04-15

Systemic reaction (other): Sore throat

Release 8 — day 21, dose 1

2021-05-03

Symptoms: Gastrointestinal issues (diarrhea, gas, abdominal cramping), significant phlegm in throat, difficulty sleeping.

Release 8 — day 0, dose 2

2021-05-10

Systemic reaction (other): Tingling in fingers and feet and cotton mouth for first 90-120 minutes after 2nd shot

Release 8 — days 1–6 daily, dose 2

2021-05-11

Systemic reaction (other): Itching feet and ankles; cotton mouth

2021-05-14

Systemic reaction (other): Itching ankles & feet (only since shot)

Release 11 — 12 months, dose 2

2022-05-10

Symptoms: COVID like symptoms: muscle aches, coughing, headache

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	Abdominal pain	✓	✓	✓
SD	Cough	·	·	✓
SD	Diarrhoea	✓	✓	✓
SD	Flatulence	✓	✓	✓
SD	Gastrointestinal disorder	✓	✓	✓
SD	Headache	·	·	✓
SD	Increased upper airway secretion	✓	✓	✓
SD	Insomnia	✓	✓	✓
SD	Malaise	·	·	✓
SD	Myalgia	·	·	✓
SRO	Dry mouth	✓	✓	✓
SRO	Feeling cold	○	✓	○
SRO	Feeling hot	○	✓	○
SRO	Feeling of body temperature change	✓	·	✓
SRO	Oropharyngeal pain	✓	✓	✓
SRO	Paraesthesia	✓	✓	✓
SRO	Pruritus	✓	✓	✓
SRO	Thirst	✓	✓	✓

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