3EN-21768-32357
4 vaccinations
10 coded responses
26 check-ins
10 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 917 / CA
- Registered
- 2021-11-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Registered dependents
TC8-29010-70154
Child or adolescent in my care · Male · 2021-11-17
Timeline
-
2021-04-03
Dose 1 — Moderna
-
2021-05-01
Dose 2 — Moderna
-
2021-11-15
Dose 3 — Moderna
-
2021-11-17
Registered in v-safe
-
2021-11-17
Survey response — days 1–6 daily, dose 3MedDRA: Lymphadenopathy — Feeling: Fair · Site: Pain, Swelling · NauseaFree text: Swollen axillary lymph nodes in the arm that received the vaccineMedDRA releases: 2024-11 · check-in free text available
-
2021-11-18
Survey response — days 1–6 daily, dose 3MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain, Swelling · NauseaFree text: Axillary lymph nodes are swollen in arm that received the injectionMedDRA releases: 2024-11 · check-in free text available
-
2021-11-19
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Nausea · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-20
- 2021-11-22
-
2021-11-29
Survey response — day 14, dose 3MedDRA: Chest pain, Heart rate increased — Feeling: Good · Be unable to do your normal daily activitiesFree text: Elevated heart rate, chest painMedDRA releases: 2024-11 · check-in free text available
- 2021-12-08
-
2021-12-13
Survey response — day 28, dose 3MedDRA: Chest pain, Dyspnoea, Nausea — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Nausea, shortness of breath, chest painMedDRA releases: 2024-11 · check-in free text available
- 2021-12-22
- 2021-12-27
- 2022-02-14
- 2022-05-18
-
2022-09-30
Dose 4 — ModernaCo-administered: Flu
- 2022-09-30
-
2022-10-01
Survey response — days 1–6 daily, dose 4MedDRA: Dyspepsia — Feeling: Fair · Site: Pain · Nausea, Abdominal painFree text: Severe indigestion despite no changes in dietMedDRA releases: 2024-11 · check-in free text available
-
2022-10-02
Survey response — days 1–6 daily, dose 4MedDRA: Dyspepsia, Gastrooesophageal reflux disease, Lymphadenopathy — Feeling: Good · Site: Pain · Abdominal pain · Be unable to do your normal daily activitiesFree text: Swollen axillary lymph nodes in the vaccinated arm, severe indigestion and reflux despite no changes in dietMedDRA releases: 2024-11 · check-in free text available
-
2022-10-03
Survey response — days 1–6 daily, dose 4MedDRA: Dyspepsia, Lymphadenopathy — Feeling: Fair · Site: Pain · Nausea · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Swelling of axillary lymph nodes in arm that received the injection, moderate indigestion despite no changes in dietMedDRA releases: 2024-11 · check-in free text available
- 2022-10-05
- 2022-10-06
- 2022-10-07
- 2022-10-14
- 2022-10-23
-
2022-10-28
Survey response — day 28, dose 4MedDRA: Cough — Feeling: GoodFree text: Persistent dry coughMedDRA releases: 2024-11 · check-in free text available
-
2022-11-04
Survey response — day 35, dose 4MedDRA: Cough — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Persistent dry coughMedDRA releases: 2024-11 · check-in free text available
-
2022-11-11
Survey response — day 42, dose 4MedDRA: Aphasia, Cough — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Persistent dry cough disruptive to the point that I have difficulty speaking full sentences.MedDRA releases: 2024-11 · check-in free text available
- 2022-12-30
- 2023-04-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-03 | Moderna | No |
| 2 | 2021-05-01 | Moderna | No |
| 3 | 2021-11-15 | Moderna | No |
| 4 | 2022-09-30 | Moderna | Flu |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Swollen axillary lymph nodes in the arm that received the vaccine
Systemic reaction (other): Axillary lymph nodes are swollen in arm that received the injection
Release 10 — day 14, dose 3
Symptoms: Elevated heart rate, chest pain
Release 10 — day 28, dose 3
Symptoms: Nausea, shortness of breath, chest pain
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Severe indigestion despite no changes in diet
Systemic reaction (other): Swollen axillary lymph nodes in the vaccinated arm, severe indigestion and reflux despite no changes in diet
Systemic reaction (other): Swelling of axillary lymph nodes in arm that received the injection, moderate indigestion despite no changes in diet
Release 12 — day 28, dose 4
Symptoms: Persistent dry cough
Release 12 — day 35, dose 4
Symptoms: Persistent dry cough
Release 12 — day 42, dose 4
Symptoms: Persistent dry cough disruptive to the point that I have difficulty speaking full sentences.
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 | Aphasia | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Heart rate increased | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SRO | Dyspepsia | · | · | ✓ |
| SRO | Gastrooesophageal reflux disease | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release