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Z3P-53894-56187

2 vaccinations 5 coded responses 21 check-ins 5 free-text entries 1 call case
Sex
Female
Age at first dose
66+
ZIP prefix
836 / ID
Registered
2021-02-09
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-05
    Dose 1 — Moderna
  2. 2021-02-09
    Registered in v-safe
  3. 2021-02-09
    Survey response — days 1–6 daily, dose 1
    MedDRA: Blood pressure increased, Burning sensation, Emergency care, Oral discomfort, Pruritus, Tongue discomfort — Feeling: Good · Site: Itching · Joint pains
    Free text: Itching, burning of tongue, mouth, palms, ankles & feet. Vaccine at 11 am on 2/5/21 at 8 pm BP 168/80 went to ER given 25 mg Benadryl and, sent home and 25 mg Benadryl at midnight Next day ok. Wondering if second doze of Moderna is recommended
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-10
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  5. 2021-02-11
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-02-12
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-02-19
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  8. 2021-02-26
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  9. 2021-03-05
    Dose 2 — Moderna
  10. 2021-03-05
    Health check-in — day 0, dose 2
    Feeling: Good · Headache, Fatigue or tiredness
    Adult check-in
  11. 2021-03-06
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pruritus, Self-medication — Feeling: Good · Site: Pain · Fatigue or tiredness
    Free text: Used 25 mg Benadryl after injection for itching
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-03-07
    Survey response — days 1–6 daily, dose 2
    MedDRA: Nodule, Pain in extremity — Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness
    Free text: Pain on underside of arm that was injected. Opposite arm (first injection) has a knot
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-03-08
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Headache, Joint pains
    Adult check-in
  14. 2021-03-09
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-03-10
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-03-11
    Survey response — days 1–6 daily, dose 2
    MedDRA: Nodule — Feeling: Good
    Free text: Just have little knot in left arm from first vaccine
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-03-12
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-03-19
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  19. 2021-03-26
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-04-02
    Survey response — day 28, dose 2
    MedDRA: Headache, Neck pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Headache Pain in nape of neck
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-04-02
    Report sent to call center — day 28, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  22. 2021-04-09
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-04-16
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-06-04
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-06-11
  26. 2021-09-03
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-02-05Moderna
22021-03-05Moderna

Call center

ReportedOutcomeVAERS-related outcome
2021-04-02 Unsuccessful

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-09

Systemic reaction (other): Itching, burning of tongue, mouth, palms, ankles & feet. Vaccine at 11 am on 2/5/21 at 8 pm BP 168/80 went to ER given 25 mg Benadryl and, sent home and 25 mg Benadryl at midnight Next day ok. Wondering if second doze of Moderna is recommended

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Used 25 mg Benadryl after injection for itching

2021-03-07

Systemic reaction (other): Pain on underside of arm that was injected. Opposite arm (first injection) has a knot

2021-03-11

Systemic reaction (other): Just have little knot in left arm from first vaccine

Release 6 — day 28, dose 2

2021-04-02

Symptoms: Headache Pain in nape of neck

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
SDHeadache ✓ ✓ ✓
SDNeck pain ✓ ✓ ✓
SROBlood pressure increased ✓ ✓ ✓
SROBurning sensation ✓ ✓ ✓
SROEmergency care ✓ ✓ ✓
SRONodule ✓ ✓ ✓
SROOral discomfort ✓ ✓ ✓
SROPain in extremity ✓ ✓ ✓
SROPruritus ✓ ✓ ✓
SROSelf-medication ✓ ✓ ✓
SROTongue discomfort ✓ ✓ ✓

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

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