3KN-28935-64477
4 vaccinations
4 coded responses
10 check-ins
4 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 300 / GA
- Registered
- 2021-04-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
LAF-24963-36366
Child or adolescent in my care · Female · 2021-11-18
Timeline
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2021-03-24
Dose 1 — Moderna
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2021-04-22
Dose 2 — Moderna
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2021-04-24
Registered in v-safe
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2021-04-24
Survey response — days 1–6 daily, dose 2MedDRA: Pyrexia, Vomiting — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activitiesFree text: Symptoms have improved from yesterday when I was vomiting and had a fever of between 102 and 103 F for about 12 hours.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-01
Health check-in — day 7, dose 2Feeling: Poor · Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
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2021-12-23
Dose 3 — Moderna
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2021-12-23
Survey response — day 0, dose 3MedDRA: Arthralgia, Chills, Immediate post-injection reaction — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Joint pain started within 30 minutes after injection. Extreme chills started at 3.5 hours post injection. All symptoms worseningMedDRA releases: 2024-11 · check-in free text available
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2021-12-24
Survey response — days 1–6 daily, dose 3MedDRA: Self-medication, Urticaria — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesFree text: I developed hives yesterday about 6 hours post injection. They responded to a dose of fexafenodene (180mg Allegra 24 hour) and external witch hazel spray (because I didn't want to add anything heavier into the mix).MedDRA releases: 2024-11 · check-in free text available
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2021-12-25
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain, Redness, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-12-26
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection siteAdult check-in
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2021-12-27
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Itching · Fever · Headache, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesAdult check-in
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2021-12-28
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fever · Fatigue or tiredness, Nausea, Abdominal painAdult check-in
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2021-12-29
Survey response — days 1–6 daily, dose 3MedDRA: Facial pain, Pain in jaw, Sinus headache, Toothache — Feeling: Poor · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to do your normal daily activitiesFree text: Sinus headachecheekbones and upper teeth/jaw hurtMedDRA releases: 2024-11 · check-in free text available
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2022-05-18
Dose 4 — Moderna
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2022-05-21
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Swelling, Itching · Fatigue or tirednessAdult check-in
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-24 | Moderna | |
| 2 | 2021-04-22 | Moderna | |
| 3 | 2021-12-23 | Moderna | No |
| 4 | 2022-05-18 | Moderna | No |
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Symptoms have improved from yesterday when I was vomiting and had a fever of between 102 and 103 F for about 12 hours.
Release 10 — day 0, dose 3
Systemic reaction (other): Joint pain started within 30 minutes after injection. Extreme chills started at 3.5 hours post injection. All symptoms worsening
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): I developed hives yesterday about 6 hours post injection. They responded to a dose of fexafenodene (180mg Allegra 24 hour) and external witch hazel spray (because I didn't want to add anything heavier into the mix).
Systemic reaction (other): Sinus headachecheekbones and upper teeth/jaw hurt
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 |
|---|---|---|---|---|
| SRO | Arthralgia | · | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Facial pain | · | · | ✓ |
| SRO | Immediate post-injection reaction | · | · | ✓ |
| SRO | Pain in jaw | · | · | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Self-medication | · | · | ✓ |
| SRO | Sinus headache | · | · | ✓ |
| SRO | Toothache | · | · | ✓ |
| SRO | Urticaria | · | · | ✓ |
| SRO | Vomiting | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release