2LB-21057-49567
3 vaccinations
6 coded responses
24 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 070 / NJ
- Registered
- 2021-04-19
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-19
Registered in v-safe
-
2021-04-19
Dose 1 — Moderna
-
2021-04-19
Survey response — day 0, dose 1MedDRA: No adverse event — Feeling: Good · Site: PainFree text: None at this time. Will monitor for 72hours.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-20
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Good · Site: PainFree text: Still doing self monitoring.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-21
- 2021-04-22
- 2021-04-23
- 2021-04-24
- 2021-04-25
- 2021-04-28
- 2021-05-03
- 2021-05-11
-
2021-05-17
Dose 2 — Moderna
-
2021-05-17
Survey response — day 0, dose 2MedDRA: Unevaluable event — Feeling: Fair · Site: PainFree text: Will continue to monitor self.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-18
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches · Be unable to do your normal daily activitiesAdult check-in
-
2021-05-19
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Fair · Site: Pain, Swelling · Be unable to do your normal daily activitiesFree text: Will continue to monitor since I got side effect the night after I got the vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-21
- 2021-05-22
- 2021-05-27
- 2021-05-31
- 2021-06-07
- 2021-06-14
- 2021-06-23
- 2021-06-28
- 2021-08-16
-
2022-04-28
Dose 3 — Moderna
-
2022-10-27
Survey response — 6 months, dose 3MedDRA: Pruritus, Urticaria — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Severe skin itch. Hives.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-27
Report sent to call center — 6 months, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2022-10-28
-
2023-04-30
Survey response — 12 months, dose 3MedDRA: Pruritus, Urticaria — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-19 | Moderna | |
| 2 | 2021-05-17 | Moderna | |
| 3 | 2022-04-28 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-27 | Unsuccessful |
Free text
Release 7 — day 0, dose 1
Systemic reaction (other): None at this time. Will monitor for 72hours.
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): Still doing self monitoring.
Release 8 — day 0, dose 2
Systemic reaction (other): Will continue to monitor self.
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Will continue to monitor since I got side effect the night after I got the vaccine
Release 12 — 6 months, dose 3
Symptoms: Severe skin itch. Hives.
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 | Pruritus | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release