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3T7-91733-55006

4 vaccinations 5 coded responses 19 check-ins 5 free-text entries 0 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
921 / CA
Registered
2021-02-01
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-01
    Registered in v-safe
  2. 2021-02-01
    Dose 1 — Moderna
  3. 2021-02-02
    Survey response — days 1–6 daily, dose 1
    MedDRA: Pain in extremity — Feeling: Good · Fatigue or tiredness
    Free text: Arm slightly sore
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-04
    Survey response — days 1–6 daily, dose 1
    MedDRA: Adverse reaction — Feeling: Good
    Free text: Yes I have to change my 2 nd dose Moderna time on 3/1 to 11:30 or later due to another appointment I didnt realize I had. How should I do that? Thank you! (b)(6)
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-02-06
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-02-15
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  7. 2021-02-24
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  8. 2021-03-01
    Survey response — day 28, dose 1
    MedDRA: Headache — Feeling: Fair
    Free text: Dull headaches off and on for several days - maybe 4 of the last 6-7 days. Located in left temple area. I typically dont get headaches so Im wondering if they might be COVID vaccine- related.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-03-09
    Dose 2 — Moderna
  10. 2021-03-10
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  11. 2021-03-11
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  12. 2021-03-13
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  13. 2021-03-16
    Health check-in — day 7, dose 2
    Feeling: Good · Headache
    Adult check-in
  14. 2021-03-23
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-04-01
    Survey response — day 21, dose 2
    MedDRA: Headache, Self-medication — Feeling: Fair
    Free text: Slight headache off and Oliver past few days- twice I had to take Advil to resolve
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-04-20
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-09-09
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-11-18
    Dose 3 — Moderna
  19. 2022-07-13
    Dose 4 — Moderna
  20. 2022-07-13
    Survey response — day 0, dose 4
    MedDRA: Fatigue, Headache, SARS-CoV-2 test negative, Sneezing — Feeling: Good · Headache, Fatigue or tiredness
    Free text: Above symptoms (HA, Fatigue light. Just started sneezing- which I did yesterday before 2nd booster. But my home Covid test was negative so I got booster.
    MedDRA releases: 2024-11 · check-in free text available
  21. 2022-07-14
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Site: Redness · Headache, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  22. 2022-07-15
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  23. 2022-07-16
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  24. 2022-07-17
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-02-01Moderna
22021-03-09Moderna
32021-11-18Moderna No
42022-07-13Moderna No

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-02

Systemic reaction (other): Arm slightly sore

2021-02-04

Systemic reaction (other): Yes I have to change my 2 nd dose Moderna time on 3/1 to 11:30 or later due to another appointment I didnt realize I had. How should I do that? Thank you! (b)(6)
redacted (b)(6)

Release 4 — day 28, dose 1

2021-03-01

Symptoms: Dull headaches off and on for several days - maybe 4 of the last 6-7 days. Located in left temple area. I typically dont get headaches so Im wondering if they might be COVID vaccine- related.

Release 6 — day 21, dose 2

2021-04-01

Symptoms: Slight headache off and Oliver past few days- twice I had to take Advil to resolve

Release 12 — day 0, dose 4

2022-07-13

Systemic reaction (other): Above symptoms (HA, Fatigue light. Just started sneezing- which I did yesterday before 2nd booster. But my home Covid test was negative so I got booster.

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
SDHeadache ✓ ✓ ✓
SDSelf-medication ✓ ✓ ✓
SROAdverse reaction ✓ ✓ ✓
SROFatigue · · ✓
SROHeadache · · ✓
SROPain in extremity ✓ ✓ ✓
SROSARS-CoV-2 test negative · · ✓
SROSneezing · · ✓

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