ZZE-56863-13534

4 vaccinations 10 coded responses 42 check-ins 9 free-text entries 2 call cases

Sex: Female
Age at first dose: 36-40
ZIP prefix: 128 / NY
Registered: 2021-01-07

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Registered dependents

4EJ-24889-74390 Child or adolescent in my care · Female · 2021-08-13

WYY-91110-76992 Child or adolescent in my care · Female · 2022-11-14

Timeline

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

2021-01-07
Registered in v-safe
2021-01-07
Dose 1 — Moderna
2021-01-07
Health check-in — day 0, dose 1
Feeling: Good · None

Adult check-in
2021-01-08
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain, Redness · Headache, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-09
Health check-in — days 1–6 daily, dose 1
Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities

Adult check-in
2021-01-09
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities

1 call case(s)
2021-01-10
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Headache

Adult check-in
2021-01-11
Health check-in — days 1–6 daily, dose 1
Feeling: Good · None

Adult check-in
2021-01-12
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Site: Pain · Muscle or body aches

Adult check-in
2021-01-13
Health check-in — days 1–6 daily, dose 1
Feeling: Good · Joint pains, Muscle or body aches

Adult check-in
2021-01-14
Health check-in — day 7, dose 1
Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-01-21
Survey response — day 14, dose 1
MedDRA: Axillary pain, Injection site erythema — Feeling: Good

Free text: Day 8 post vaccine: dime sized red spot at injection site along with pain/ ache in both axillary regions, left worse than right. 5/10 on pain scale. Lasted about 24 hours.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-01-28
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-02-04
Dose 2 — Moderna
2021-02-04
Health check-in — day 0, dose 2
Feeling: Good · Site: Pain · Joint pains

Adult check-in
2021-02-05
Survey response — days 1–6 daily, dose 2
MedDRA: Dizziness — Feeling: Fair · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Lightheaded

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-06
Survey response — days 1–6 daily, dose 2
MedDRA: Pain of skin — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Surface of my skin feels painful

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-07
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Site: Pain · Fatigue or tiredness

Adult check-in
2021-02-08
Health check-in — days 1–6 daily, dose 2
Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-02-09
Survey response — days 1–6 daily, dose 2
MedDRA: Axillary pain, Pain in extremity, Peripheral swelling, Tenderness — Feeling: Good · Site: Pain · Joint pains, Muscle or body aches

Free text: Swelling on upper left arm below level of deltoid to elbow, pain in tricep muscle and elbow, right axillary pain and tenderness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-10
Survey response — days 1–6 daily, dose 2
MedDRA: Lymph node pain, Pain in extremity, Peripheral swelling — Feeling: Good · Muscle or body aches

Free text: Bilateral axillary tenderness; pain and swelling above left elbow

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-11
Survey response — day 7, dose 2
MedDRA: Arthralgia, Axillary pain, Tenderness — Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Left elbow pain, bilatetal axillary pain and tenderness, left worse than right

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-18
Survey response — day 14, dose 2
MedDRA: Oral herpes — Feeling: Good

Free text: HSV blister on lip

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-02-25
Health check-in — day 21, dose 2
Feeling: Good

Adult check-in
2021-03-06
Health check-in — day 28, dose 2
Feeling: Good

Adult check-in
2021-03-11
Health check-in — day 35, dose 2
Feeling: Good

Adult check-in
2021-03-18
Health check-in — day 42, dose 2
Feeling: Good

Adult check-in
2021-05-06
Health check-in — 3 months, dose 2
Feeling: Good

Adult check-in
2021-08-05
Health check-in — 6 months, dose 2
Feeling: Good

Adult check-in
2021-11-23
Dose 3 — Moderna
2021-11-25
Health check-in — days 1–6 daily, dose 3
Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-27
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-28
Survey response — days 1–6 daily, dose 3
MedDRA: Paraesthesia — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness

Free text: Tingling in both hands/fingertips, right greater than left

MedDRA releases: 2024-11 · check-in free text available
2021-11-29
Health check-in — days 1–6 daily, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-11-30
Health check-in — day 7, dose 3
Feeling: Good · Muscle or body aches, Fatigue or tiredness

Adult check-in
2021-12-07
Health check-in — day 14, dose 3
Feeling: Good

Adult check-in
2021-12-14
Health check-in — day 21, dose 3
Feeling: Good

Adult check-in
2021-12-21
Health check-in — day 28, dose 3
Feeling: Fair

Adult check-in
2021-12-28
Health check-in — day 35, dose 3
Feeling: Good

Adult check-in
2022-01-06
Health check-in — day 42, dose 3
Feeling: Good

Adult check-in
2022-02-23
Health check-in — 3 months, dose 3
Feeling: Good

Adult check-in
2022-05-24
Health check-in — 6 months, dose 3
Feeling: Good

Adult check-in
2022-10-28
Dose 4 — Moderna
2022-11-14
Health check-in — day 14, dose 4
Feeling: Good

Adult check-in
2022-11-27
Health check-in — day 28, dose 4
Feeling: Good

Adult check-in
2022-12-02
Health check-in — day 35, dose 4
Feeling: Good

Adult check-in
2022-12-09
Survey response — day 42, dose 4
MedDRA: Asthma, Pre-existing disease — Feeling: Good

Free text: Asthma flare up 1 week ago. No COVID or febrile illness.

MedDRA releases: 2024-11 · check-in free text available
2023-01-29
Survey response — 3 months, dose 4
MedDRA: Lyme disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-01-29
Report sent to call center — 3 months, dose 4
Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-01-30
Call successful
Not applicable - Accidental Reporting

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-01-07	Moderna
2	2021-02-04	Moderna
3	2021-11-23	Moderna	No
4	2022-10-28	Moderna	No

Call center

2 call center cases

1 successful · 1 priority 2/3 (triaged and no follow up)

See the call center timeline

Free text

Release 2 — day 14, dose 1

2021-01-21

Symptoms: Day 8 post vaccine: dime sized red spot at injection site along with pain/ ache in both axillary regions, left worse than right. 5/10 on pain scale. Lasted about 24 hours.

Release 3 — days 1–6 daily, dose 2

2021-02-05

Systemic reaction (other): Lightheaded

2021-02-06

Systemic reaction (other): Surface of my skin feels painful

2021-02-09

Systemic reaction (other): Swelling on upper left arm below level of deltoid to elbow, pain in tricep muscle and elbow, right axillary pain and tenderness

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): Bilateral axillary tenderness; pain and swelling above left elbow

Release 4 — day 7, dose 2

2021-02-11

Systemic reaction (other): Left elbow pain, bilatetal axillary pain and tenderness, left worse than right

Release 4 — day 14, dose 2

2021-02-18

Symptoms: HSV blister on lip

Release 10 — days 1–6 daily, dose 3

2021-11-28

Systemic reaction (other): Tingling in both hands/fingertips, right greater than left

Release 12 — day 42, dose 4

2022-12-09

Symptoms: Asthma flare up 1 week ago. No COVID or febrile illness.

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	Asthma	·	·	✓
SD	Axillary pain	✓	✓	✓
SD	Injection site erythema	✓	✓	✓
SD	Lyme disease	·	·	✓
SD	Oral herpes	✓	✓	✓
SD	Pre-existing disease	·	·	✓
SRO	Arthralgia	✓	✓	✓
SRO	Axillary pain	✓	✓	✓
SRO	Dizziness	✓	✓	✓
SRO	Lymph node pain	✓	✓	✓
SRO	Pain in extremity	✓	✓	✓
SRO	Pain of skin	✓	✓	✓
SRO	Paraesthesia	·	·	✓
SRO	Peripheral swelling	✓	✓	✓
SRO	Tenderness	✓	✓	✓

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