3U4-25794-14900
5 vaccinations
8 coded responses
47 check-ins
8 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 670 / KS
- Registered
- 2021-03-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-04
Registered in v-safe
-
2021-03-04
Dose 1 — Moderna
-
2021-03-05
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus — Feeling: Good · Site: Pain, Swelling, ItchingFree text: yesterday my whole are and hand itchedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-10
- 2021-03-11
- 2021-03-18
- 2021-03-27
-
2021-04-01
Dose 2 — Moderna
-
2021-04-02
Survey response — days 1–6 daily, dose 2MedDRA: Pain of skin — Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: pain in different points of my skin as if someone was randomly pinching meMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-08
- 2021-04-15
-
2021-04-22
Survey response — day 21, dose 2MedDRA: Dizziness, Hypotension — Feeling: Good · Be unable to do your normal daily activitiesFree text: Yesterday my blood pressure was low and I felt light headed. May be due to something elseMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-29
- 2021-05-13
-
2021-07-01
Survey response — 3 months, dose 2MedDRA: Herpes zoster, Pyrexia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: I got a shingles shot and had a 104 fever for 12 hoursMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-10-02
Dose 3 — Moderna
- 2021-10-28
- 2021-10-30
- 2021-11-06
- 2021-11-13
-
2022-01-01
Survey response — 3 months, dose 3MedDRA: Abnormal sensation in eye, Cough, Eye disorder, Eyelid ptosis, Rhinorrhoea, SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Tested positive for Covid after traveling to Mexico Cough. Runny nose and weird eye problems. Eye felt dry and droopyMedDRA releases: 2024-11 · check-in free text available
- 2022-04-02
-
2022-04-18
Dose 4 — Moderna
-
2022-04-19
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activitiesAdult check-in
-
2022-04-22
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Redness, Swelling, Itching · NoneAdult check-in
- 2022-04-23
-
2022-04-24
Survey response — days 1–6 daily, dose 4MedDRA: Pulmonary pain — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Pain in my lung left sideMedDRA releases: 2024-11 · check-in free text available
- 2022-04-25
- 2022-05-02
- 2022-05-11
- 2022-05-16
- 2022-05-26
- 2022-05-30
- 2022-07-18
-
2022-10-17
Survey response — 6 months, dose 4MedDRA: Cough — Feeling: GoodFree text: A persistent coughMedDRA releases: 2024-11 · check-in free text available
-
2022-12-13
Dose 5 — Moderna
-
2022-12-14
Survey response — days 1–6 daily, dose 5MedDRA: No adverse event — Feeling: Good · Site: Pain, SwellingFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-12-16
- 2022-12-18
-
2022-12-20
Health check-in — day 7, dose 5Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2022-12-27
- 2023-01-10
- 2023-01-17
- 2023-01-24
- 2023-03-14
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-04 | Moderna | |
| 2 | 2021-04-01 | Moderna | |
| 3 | 2021-10-02 | Moderna | No |
| 4 | 2022-04-18 | Moderna | No |
| 5 | 2022-12-13 | Moderna | No |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): yesterday my whole are and hand itched
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): pain in different points of my skin as if someone was randomly pinching me
Release 7 — day 21, dose 2
Symptoms: Yesterday my blood pressure was low and I felt light headed. May be due to something else
Release 9 — 3 months, dose 2
Symptoms: I got a shingles shot and had a 104 fever for 12 hours
Release 10 — 3 months, dose 3
Symptoms: Tested positive for Covid after traveling to Mexico Cough. Runny nose and weird eye problems. Eye felt dry and droopy
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Pain in my lung left side
Release 12 — 6 months, dose 4
Symptoms: A persistent cough
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): No
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 | Abnormal sensation in eye | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Eye disorder | · | · | ✓ |
| SD | Eyelid ptosis | · | · | ✓ |
| SD | Herpes zoster | ✓ | ✓ | ✓ |
| SD | Hypotension | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Pain of skin | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Pulmonary pain | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release