3Z2-21165-08100
3 vaccinations
2 coded responses
42 check-ins
2 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 762 / TX
- Registered
- 2021-02-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-02
Registered in v-safe
-
2021-02-02
Dose 1 — Moderna
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-16
- 2021-02-23
- 2021-03-02
-
2021-03-04
Dose 2 — Moderna
- 2021-03-04
-
2021-03-05
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Fatigue or tirednessAdult check-in
- 2021-03-06
-
2021-03-07
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness · HeadacheAdult check-in
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-20
- 2021-03-25
- 2021-04-01
- 2021-04-08
- 2021-04-15
- 2021-06-03
-
2021-09-02
Survey response — 6 months, dose 2MedDRA: COVID-19, Diabetes mellitus, Drug hypersensitivity, Emergency care, Hypersensitivity, Office visit, Pharyngeal swelling, Pharyngitis streptococcal, Swollen tongue — Feeling: Good · 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 visit, Emergency room or emergency department visitFree text: Symptoms: Diagnosed with Covid 19 last week of July Severe Allergic reaction and throat and tongue swelling during Covid 19 and got strep throat during covid reaction was to medication I always take and had to go to ER also diagnosed with diabetes · Healthcare visit (other): Dr officeMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-09-02
Report sent to call center — 6 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2021-09-07
-
2021-10-28
Dose 3 — Moderna
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-11
- 2021-11-18
- 2021-11-25
- 2021-12-02
- 2021-12-09
- 2022-01-29
- 2022-04-28
-
2022-10-30
Survey response — 12 months, dose 3MedDRA: Blood glucose decreased, Condition aggravated, Pre-existing disease, Reaction to previous exposure to any vaccine — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: I am type 2 diabetic and I noticed after the shot for a few weeks my blood sugar was low a lot. The previous shot did As well but not as bad as this time. I was thinking maybe because it was the new shot.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-30
Report sent to call center — 12 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2022-10-31
- 2022-10-31
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-02 | Moderna | |
| 2 | 2021-03-04 | Moderna | |
| 3 | 2021-10-28 | Moderna | No |
Call center
2 call center cases
2 unsuccessful
Free text
Release 9 — 6 months, dose 2
Symptoms: Diagnosed with Covid 19 last week of July Severe Allergic reaction and throat and tongue swelling during Covid 19 and got strep throat during covid reaction was to medication I always take and had to go to ER also diagnosed with diabetes
Healthcare visit (other): Dr office
Release 12 — 12 months, dose 3
Symptoms: I am type 2 diabetic and I noticed after the shot for a few weeks my blood sugar was low a lot. The previous shot did As well but not as bad as this time. I was thinking maybe because it was the new shot.
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 |
|---|---|---|---|---|
| HCVO | Office visit | ✓ | · | ✓ |
| SD | Blood glucose decreased | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | COVID-19 | ✓ | · | ✓ |
| SD | Diabetes mellitus | ✓ | · | ✓ |
| SD | Drug hypersensitivity | ✓ | · | ✓ |
| SD | Emergency care | ✓ | · | ✓ |
| SD | Hypersensitivity | ✓ | · | ✓ |
| SD | Pharyngeal swelling | ✓ | · | ✓ |
| SD | Pharyngitis streptococcal | ✓ | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Reaction to previous exposure to any vaccine | · | · | ✓ |
| SD | Swollen tongue | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release