3CU-66055-77338
2 vaccinations
3 coded responses
17 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 356 / AL
- Registered
- 2021-01-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-30
Dose 1 — Moderna
-
2021-01-03
Registered in v-safe
- 2021-01-03
-
2021-01-04
Survey response — days 1–6 daily, dose 1MedDRA: Vitreous floaters — Feeling: GoodFree text: For several hours yesterday evening, I saw a black thread that seemed to be floating in the air. Only experienced this with my right eye. I've never seen anything like this before. The thread broke up and the pieces got smaller and smaller until they went away. Very strange.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-05
- 2021-01-07
- 2021-01-13
- 2021-01-21
- 2021-01-27
-
2021-01-29
Dose 2 — Moderna
- 2021-02-03
-
2021-02-04
Survey response — days 1–6 daily, dose 2MedDRA: Insomnia, Malaise, Pain — Feeling: Good · Site: PainFree text: The weekend after the shot on Friday, I had body aches, insomnia, and malaise. Symptoms stopped by Sunday night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-05
- 2021-02-12
- 2021-02-21
- 2021-02-26
-
2021-03-06
Survey response — day 35, dose 2MedDRA: Herpes zoster — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Shingles affecting left torso.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-06
Report sent to call center — day 35, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-12
- 2021-04-30
- 2021-08-01
-
2021-10-22
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-30 | Moderna | |
| 2 | 2021-01-29 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): For several hours yesterday evening, I saw a black thread that seemed to be floating in the air. Only experienced this with my right eye. I've never seen anything like this before. The thread broke up and the pieces got smaller and smaller until they went away. Very strange.
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): The weekend after the shot on Friday, I had body aches, insomnia, and malaise. Symptoms stopped by Sunday night.
Release 5 — day 35, dose 2
Symptoms: Shingles affecting left torso.
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 | Herpes zoster | ✓ | ✓ | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
| SRO | Malaise | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Vitreous floaters | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release