3F8-19068-01140
4 vaccinations
3 coded responses
49 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 546 / WI
- Registered
- 2021-03-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
Y4Z-17526-68762
Child or adolescent in my care · Female · 2021-11-26
FW7-12461-95947
Child or adolescent in my care · Female · 2021-12-27
Timeline
-
2021-03-19
Registered in v-safe
-
2021-03-19
Dose 1 — Moderna
-
2021-03-19
Survey response — day 0, dose 1MedDRA: Dizziness — Feeling: Good · HeadacheFree text: Mild DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-20
-
2021-03-21
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to workAdult check-in
-
2021-03-22
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to workAdult check-in
-
2021-03-23
Survey response — days 1–6 daily, dose 1MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessFree text: DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-24
- 2021-03-25
- 2021-03-26
- 2021-04-03
- 2021-04-11
-
2021-04-16
Dose 2 — Moderna
- 2021-04-16
-
2021-04-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
-
2021-04-19
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-20
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-04-21
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Redness, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-04-23
Health check-in — day 7, dose 2Feeling: Fair · Site: Redness · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-04-30
- 2021-05-07
- 2021-05-14
- 2021-05-22
- 2021-05-28
- 2021-07-18
- 2021-10-15
-
2021-11-19
Dose 3 — Moderna
-
2021-11-20
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-11-21
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-22
- 2021-11-23
- 2021-11-24
- 2021-11-25
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2021-12-17
- 2021-12-24
- 2021-12-31
- 2022-02-18
-
2022-05-20
Survey response — 6 months, dose 3MedDRA: Bronchitis, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Covid, then post-covid bronchitisMedDRA releases: 2024-11 · check-in free text available
-
2022-05-20
Report sent to call center — 6 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-05-24
- 2022-11-21
-
2022-12-02
Dose 4 — Moderna
-
2022-12-03
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-12-04
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-12-06
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-12-08
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-12-09
Health check-in — day 7, dose 4Feeling: Fair · Site: Swelling · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-12-16
- 2022-12-25
- 2022-12-30
- 2023-01-06
- 2023-01-13
- 2023-03-03
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-19 | Moderna | |
| 2 | 2021-04-16 | Moderna | |
| 3 | 2021-11-19 | Moderna | No |
| 4 | 2022-12-02 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-05-20 | Unsuccessful |
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): Mild Dizziness
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): Dizziness
Release 11 — 6 months, dose 3
Symptoms: Covid, then post-covid bronchitis
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 | Bronchitis | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release