39U-48321-78348
2 vaccinations
4 coded responses
26 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 762 / TX
- Registered
- 2021-02-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-12
Registered in v-safe
-
2021-02-12
Dose 1 — Moderna
-
2021-02-12
Survey response — day 0, dose 1MedDRA: Dyspepsia — Feeling: Good · HeadacheFree text: IndigestionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-26
- 2021-03-05
-
2021-03-12
Dose 2 — Moderna
- 2021-03-12
-
2021-03-13
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-14
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-15
Survey response — days 1–6 daily, dose 2MedDRA: Vaccine positive rechallenge — Feeling: Good · Site: PainFree text: A pain/tightness on the insid of my upper left arm. Same arm that I got the shot in. This is not the first time I have had this. It started a few days after the first shot in the same place and lasted for over a week before it got better.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-16
Survey response — days 1–6 daily, dose 2MedDRA: Muscle tightness, Pain in extremity — Feeling: Good · Site: PainFree text: Pain/tightness on the inside of my left upper armMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-04-23
- 2021-06-11
- 2021-09-10
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2022-03-12
Survey response — 12 months, dose 2MedDRA: Hip arthroplasty, Pre-existing disease — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: I had a mild case of Covid-19. Tested positive on 1/17/2021. I also had a total hip replacement surgery on 2/9/2022.MedDRA releases: 2024-11 · check-in free text available
-
2022-03-12
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2022-03-14
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-12 | Moderna | |
| 2 | 2021-03-12 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 4 — day 0, dose 1
Systemic reaction (other): Indigestion
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): A pain/tightness on the insid of my upper left arm. Same arm that I got the shot in. This is not the first time I have had this. It started a few days after the first shot in the same place and lasted for over a week before it got better.
Systemic reaction (other): Pain/tightness on the inside of my left upper arm
Release 11 — 12 months, dose 2
Symptoms: I had a mild case of Covid-19. Tested positive on 1/17/2021. I also had a total hip replacement surgery on 2/9/2022.
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 |
|---|---|---|---|---|
| SD | Hip arthroplasty | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Dyspepsia | ✓ | ✓ | ✓ |
| SRO | Muscle tightness | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Vaccine positive rechallenge | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release