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3ER-17592-82668

1 vaccination 7 coded responses 11 check-ins 7 free-text entries 0 call cases
Sex
Female
Age at first dose
41-45
ZIP prefix
064 / CT
Registered
2021-01-11
Relationship
Self
Race
White
Ethnicity
Hispanic or Latino

Timeline

  1. 2021-01-10
    Dose 1 — Moderna
  2. 2021-01-11
    Registered in v-safe
  3. 2021-01-11
    Survey response — days 1–6 daily, dose 1
    MedDRA: Heart rate increased — Feeling: Poor · Site: Pain · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness
    Free text: Accelerated heart rate
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-01-12
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · Chills, Joint pains, Fatigue or tiredness
    Adult check-in
  5. 2021-01-13
    Survey response — days 1–6 daily, dose 1
    MedDRA: Gastrooesophageal reflux disease — Feeling: Fair · Site: Pain · Chills
    Free text: Acid Reflux first thing in AM, never had before
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Chills
    Adult check-in
  7. 2021-01-15
    Survey response — days 1–6 daily, dose 1
    MedDRA: Respiratory tract congestion, Rhinorrhoea — Feeling: Fair · Chills, Joint pains
    Free text: Mild congestion and runny nose since yesterday
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-01-16
    Survey response — days 1–6 daily, dose 1
    MedDRA: Blood glucose increased — Feeling: Fair · Fatigue or tiredness
    Free text: Higher than usual blood sugar for the last 5 days but did not think of the vaccine as the reason until today
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-01-18
    Survey response — day 7, dose 1
    MedDRA: Blood glucose increased — Feeling: Good
    Free text: Higher than usual blood sugar
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-01-24
    Survey response — day 14, dose 1
    MedDRA: Arthralgia, Chills — Feeling: Fair
    Free text: Chills and joint pains in the evenings and at night
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-02-01
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-02-07
    Health check-in — day 28, dose 1
    Feeling: Good
    Adult check-in
  13. 2022-01-13
    Survey response — 12 months, dose 1
    MedDRA: Lower urinary tract symptoms, Micturition urgency, Nervous system disorder, Pollakiuria, Temperature intolerance — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Neurogenic Bladder type of symptoms with urinary frequency and urgency onset 4 months post vaccine and continue. A full work up has been done to rule out other causes. Extreme nerve sensitivity to heat (hot water when washing dishes or showering)
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-01-10Moderna

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-11

Systemic reaction (other): Accelerated heart rate

2021-01-13

Systemic reaction (other): Acid Reflux first thing in AM, never had before

Release 2 — days 1–6 daily, dose 1

2021-01-15

Systemic reaction (other): Mild congestion and runny nose since yesterday

2021-01-16

Systemic reaction (other): Higher than usual blood sugar for the last 5 days but did not think of the vaccine as the reason until today

Release 2 — day 7, dose 1

2021-01-18

Systemic reaction (other): Higher than usual blood sugar

Release 2 — day 14, dose 1

2021-01-24

Symptoms: Chills and joint pains in the evenings and at night

Release 10 — 12 months, dose 1

2022-01-13

Symptoms: Neurogenic Bladder type of symptoms with urinary frequency and urgency onset 4 months post vaccine and continue. A full work up has been done to rule out other causes. Extreme nerve sensitivity to heat (hot water when washing dishes or showering)

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

FieldPreferred term2021-092023-042024-11
SDArthralgia ✓ ✓ ✓
SDChills ✓ ✓ ✓
SDLower urinary tract symptoms · · ✓
SDMicturition urgency · · ✓
SDNervous system disorder · · ✓
SDPollakiuria · · ✓
SDTemperature intolerance · · ✓
SROBlood glucose increased ✓ ✓ ✓
SROGastrooesophageal reflux disease ✓ ✓ ✓
SROHeart rate increased ✓ ✓ ✓
SRORespiratory tract congestion ✓ ✓ ✓
SRORhinorrhoea ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release

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