36F-20653-19640
5 vaccinations
10 coded responses
44 check-ins
10 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 778 / TX
- Registered
- 2021-02-22
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-22
Registered in v-safe
-
2021-02-22
Dose 1 — Moderna
- 2021-02-22
-
2021-02-24
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · FeverFree text: My arm is a little sore at the injection site, but nothing unusual or different from what I experience with other vaccines.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-25
Survey response — days 1–6 daily, dose 1MedDRA: Pain in extremity — Feeling: GoodFree text: Arm is still a little sore, but not anything unusual. All is well.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-08
- 2021-03-15
-
2021-03-19
Dose 2 — Moderna
-
2021-03-19
Survey response — day 0, dose 2MedDRA: Injection site pain — Feeling: GoodFree text: Injection site is sore, but it's not painfulMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-20
Survey response — days 1–6 daily, dose 2MedDRA: Injection site pain — Feeling: GoodFree text: Injection site a little soreMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-21
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Muscle or body aches, NauseaAdult check-in
- 2021-03-22
- 2021-03-23
-
2021-03-24
Survey response — days 1–6 daily, dose 2MedDRA: Injection site pain, Pain in extremity — Feeling: Good · Site: Redness · Fatigue or tirednessFree text: Injection site/arm soreMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-25
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-04-23
- 2021-04-30
- 2021-06-18
-
2021-09-17
Survey response — 6 months, dose 2MedDRA: Pneumonia bacterial — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Diagnosed 9-5-2021 with bacterial pneumonia, NOT COVID pneumoniaMedDRA releases: 2024-11 · check-in free text available
-
2021-11-19
Dose 3 — Moderna
-
2021-11-22
Survey response — days 1–6 daily, dose 3MedDRA: Vaccination site warmth — Feeling: Fair · Site: Pain, Redness · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: Arm Heat at vaccine siteMedDRA releases: 2024-11 · check-in free text available
- 2021-11-23
- 2021-11-24
- 2021-11-25
- 2021-11-26
- 2021-12-05
- 2021-12-10
- 2021-12-17
- 2021-12-24
- 2021-12-31
- 2022-02-18
-
2022-03-18
Dose 4 — Moderna
- 2022-05-22
-
2022-11-01
Dose 5 — ModernaCo-administered: Flu
-
2022-11-09
Survey response — day 7, dose 5MedDRA: SARS-CoV-2 test positive — Feeling: Poor · Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Systemic reaction (other): Tested positive for COVID 19 one week after receiving 3rd booster · Healthcare visit (other): Tested positive for COVID 19 on November 7, 2022MedDRA releases: 2024-11 · check-in free text available
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2022-11-09
Report sent to call center — day 7, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-11-10
-
2022-11-17
Survey response — day 14, dose 5MedDRA: Cough, Pain — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Body aches and severe coughMedDRA releases: 2024-11 · check-in free text available
-
2022-11-17
Report sent to call center — day 14, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-11-18
- 2022-11-18
-
2022-11-18
Call successfulDoes not wish to fill out VAERS report
-
2022-11-18
Call successfulDoes not wish to fill out VAERS report
- 2022-11-22
-
2022-11-29
Survey response — day 28, dose 5MedDRA: Cough, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Horrible cold, coughing, head congestion, Tested negative for COVID 19 on 11-28-2022MedDRA releases: 2024-11 · check-in free text available
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2022-11-29
Report sent to call center — day 28, dose 5Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-11-30
- 2022-12-06
- 2022-12-13
- 2023-01-31
- 2023-05-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-22 | Moderna | |
| 2 | 2021-03-19 | Moderna | |
| 3 | 2021-11-19 | Moderna | No |
| 4 | 2022-03-18 | Moderna | No |
| 5 | 2022-11-01 | Moderna | Flu |
Call center
3 call center cases
2 successful · 1 unsuccessful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): My arm is a little sore at the injection site, but nothing unusual or different from what I experience with other vaccines.
Systemic reaction (other): Arm is still a little sore, but not anything unusual. All is well.
Release 5 — day 0, dose 2
Systemic reaction (other): Injection site is sore, but it's not painful
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Injection site a little sore
Systemic reaction (other): Injection site/arm sore
Release 9 — 6 months, dose 2
Symptoms: Diagnosed 9-5-2021 with bacterial pneumonia, NOT COVID pneumonia
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Arm Heat at vaccine site
Release 12 — day 7, dose 5
Systemic reaction (other): Tested positive for COVID 19 one week after receiving 3rd booster
Healthcare visit (other): Tested positive for COVID 19 on November 7, 2022
Release 12 — day 14, dose 5
Symptoms: Body aches and severe cough
Release 12 — day 28, dose 5
Symptoms: Horrible cold, coughing, head congestion, Tested negative for COVID 19 on 11-28-2022
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 | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pneumonia bacterial | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Vaccination site warmth | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release