35N-30583-94080
5 vaccinations
7 coded responses
55 check-ins
7 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 323 / FL
- Registered
- 2021-01-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-19
Dose 1 — Moderna
-
2021-01-30
Registered in v-safe
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2021-01-30
Survey response — day 7, dose 1MedDRA: Asthenia, Dysgeusia, Emergency care, Flushing, Immediate post-injection reaction, Paraesthesia oral — Feeling: Good · Site: Pain · Fatigue or tiredness · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Systemic reaction (other): 2-3 min post "odd" feeling, momentary flushing surge up from feet to neck, odd taste back of tongue, general weakness, tingling back of tongue, See my EMS, tx Benadryl 25 IV/ Famotidine 10mg orally, 2 hr observe in ER, all symptoms resolved. Reported to DOH, VAERS report initiated. · Healthcare visit (other): EMS at vaccine site, tx with Benadryl/famotidine, then 2 hr observation in ER.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-30
Report sent to call center — day 7, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-02
- 2021-02-09
-
2021-02-16
Dose 2 — Moderna
-
2021-02-16
Survey response — day 0, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: Just got shot, no symptoms at presentMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-17
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-02-18
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body achesAdult check-in
- 2021-02-19
- 2021-02-20
-
2021-02-21
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Joint pains, Muscle or body achesAdult check-in
- 2021-02-22
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-05-18
- 2021-05-26
-
2021-06-08
Call successfulReported to VAERS voluntarily prior to GDIT contact
- 2021-08-17
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2021-10-16
Dose 3 — Moderna
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2021-10-26
Survey response — day 7, dose 3MedDRA: Arthralgia, Decreased appetite, Fatigue, Myalgia, Pyrexia — Feeling: Good · Site: Pain, Redness · Joint pains · Be unable to do your normal daily activitiesFree text: Joint/muscle aches, low fever, fatigue, loss appetite 10/17, 10/18MedDRA releases: 2024-11 · check-in free text available
- 2021-10-30
- 2021-11-06
- 2021-11-13
- 2021-11-20
-
2021-11-27
Survey response — day 42, dose 3MedDRA: Cough — Feeling: GoodFree text: CoughMedDRA releases: 2024-11 · check-in free text available
- 2022-01-15
- 2022-04-17
-
2022-06-09
Dose 4 — Moderna
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2022-06-09
Survey response — day 0, dose 4MedDRA: Flushing, Unevaluable event — Feeling: GoodFree text: Sensation on top tongue, vascular flush, skin and veins for 5 min.MedDRA releases: 2024-11 · check-in free text available
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2022-06-10
Survey response — days 1–6 daily, dose 4MedDRA: Angiopathy, Flushing, Hypoaesthesia oral, Immediate post-injection reaction — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: 0-5 min post injection, numb sensation middle tongue, flushed skin, vascular light up of all veins on body.MedDRA releases: 2024-11 · check-in free text available
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2022-06-11
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-06-12
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-06-13
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-06-14
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body achesAdult check-in
-
2022-06-15
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Redness, Swelling, Itching · Fatigue or tirednessAdult check-in
- 2022-06-16
- 2022-06-23
- 2022-06-30
- 2022-07-07
- 2022-07-14
- 2022-07-21
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2022-09-10
Survey response — 3 months, dose 4MedDRA: Bronchitis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Bronchitis.MedDRA releases: 2024-11 · check-in free text available
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2022-09-10
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-09-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-10-23
Dose 5 — Moderna
- 2022-10-23
-
2022-10-24
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain, Redness · Fatigue or tirednessAdult check-in
- 2022-10-25
- 2022-10-26
- 2022-10-27
- 2022-10-28
- 2022-10-29
- 2022-10-30
- 2022-11-06
- 2022-11-13
- 2022-11-20
- 2022-11-27
- 2022-12-04
- 2023-01-22
- 2023-04-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-19 | Moderna | |
| 2 | 2021-02-16 | Moderna | |
| 3 | 2021-10-16 | Moderna | No |
| 4 | 2022-06-09 | Moderna | No |
| 5 | 2022-10-23 | Moderna | No |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 1
1 wait over 3 months for a first call
Free text
Release 3 — day 7, dose 1
Systemic reaction (other): 2-3 min post "odd" feeling, momentary flushing surge up from feet to neck, odd taste back of tongue, general weakness, tingling back of tongue, See my EMS, tx Benadryl 25 IV/ Famotidine 10mg orally, 2 hr observe in ER, all symptoms resolved. Reported to DOH, VAERS report initiated.
Healthcare visit (other): EMS at vaccine site, tx with Benadryl/famotidine, then 2 hr observation in ER.
Release 4 — day 0, dose 2
Systemic reaction (other): Just got shot, no symptoms at present
Release 10 — day 7, dose 3
Systemic reaction (other): Joint/muscle aches, low fever, fatigue, loss appetite 10/17, 10/18
Release 10 — day 42, dose 3
Symptoms: Cough
Release 12 — day 0, dose 4
Systemic reaction (other): Sensation on top tongue, vascular flush, skin and veins for 5 min.
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): 0-5 min post injection, numb sensation middle tongue, flushed skin, vascular light up of all veins on body.
Release 12 — 3 months, dose 4
Symptoms: Bronchitis.
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 |
|---|---|---|---|---|
| HCVO | Emergency care | ✓ | ✓ | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SRO | Angiopathy | · | · | ✓ |
| SRO | Arthralgia | · | · | ✓ |
| SRO | Asthenia | ✓ | ✓ | ✓ |
| SRO | Decreased appetite | · | · | ✓ |
| SRO | Dysgeusia | ✓ | ✓ | ✓ |
| SRO | Emergency care | ✓ | ✓ | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Flushing | ✓ | ✓ | ✓ |
| SRO | Hypoaesthesia oral | · | · | ✓ |
| SRO | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SRO | Myalgia | · | · | ✓ |
| SRO | Paraesthesia oral | ✓ | ✓ | ✓ |
| SRO | Pyrexia | · | · | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release