36J-13664-03617
2 vaccinations
7 coded responses
18 check-ins
7 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 122 / NY
- Registered
- 2021-02-14
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-13
Dose 1 — Moderna
-
2021-02-14
Registered in v-safe
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2021-02-14
Survey response — days 1–6 daily, dose 1MedDRA: Pain in extremity, Self-medication — Feeling: Good · Site: PainFree text: I took two ibuprofen last night for the arm pain so that might be suppressing other symptoms.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-15
- 2021-02-16
- 2021-02-17
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2021-02-18
Survey response — days 1–6 daily, dose 1MedDRA: Headache — Feeling: Good · HeadacheFree text: Intermittent headache around left eye socket.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-19
- 2021-02-20
- 2021-02-27
- 2021-03-06
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2021-03-13
Dose 2 — Moderna
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2021-03-20
Survey response — day 7, dose 2MedDRA: Induration, Peripheral swelling — Feeling: Good · Site: SwellingFree text: Four days after the shot my arm felt very firm and swollen. It has since improved.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-27
Survey response — day 14, dose 2MedDRA: Abdominal pain upper, Loss of personal independence in daily activities — Feeling: FairFree text: Stomach pain though I dont think it is related to the vaccine. I have to reduce my activities today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-03
Survey response — day 21, dose 2MedDRA: Neck pain, Pain — Feeling: GoodFree text: Shooting pain in neckMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-10
Survey response — day 28, dose 2MedDRA: Gastrointestinal disorder, Nasopharyngitis, Oropharyngeal pain, Pyrexia, Rhinorrhoea — Feeling: Good · Be unable to do your normal daily activitiesFree text: GI illness apparently related to food lasting one day followed by a mild cold with sore throat, runny nose and fever lasting three days. The GI condition was debilitating.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-17
- 2021-04-24
- 2021-06-12
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2021-09-11
Survey response — 6 months, dose 2MedDRA: Arthralgia — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Right knee painMedDRA releases: 2024-11 · check-in free text available
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2021-09-11
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-20
-
2021-09-21
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-03-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-13 | Moderna | |
| 2 | 2021-03-13 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): I took two ibuprofen last night for the arm pain so that might be suppressing other symptoms.
Systemic reaction (other): Intermittent headache around left eye socket.
Release 6 — day 7, dose 2
Systemic reaction (other): Four days after the shot my arm felt very firm and swollen. It has since improved.
Release 6 — day 14, dose 2
Symptoms: Stomach pain though I dont think it is related to the vaccine. I have to reduce my activities today.
Release 6 — day 21, dose 2
Symptoms: Shooting pain in neck
Release 7 — day 28, dose 2
Symptoms: GI illness apparently related to food lasting one day followed by a mild cold with sore throat, runny nose and fever lasting three days. The GI condition was debilitating.
Release 9 — 6 months, dose 2
Symptoms: Right knee pain
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 | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Gastrointestinal disorder | ✓ | ✓ | ✓ |
| SD | Loss of personal independence in daily activities | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Neck pain | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Rhinorrhoea | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Induration | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Peripheral swelling | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release