3Z7-27455-09379
3 vaccinations
4 coded responses
8 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 871 / NM
- Registered
- 2021-03-25
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-25
Registered in v-safe
-
2021-03-25
Dose 1 — Moderna
- 2021-03-25
- 2021-03-26
- 2021-03-27
-
2021-04-21
Dose 2 — Moderna
-
2021-11-04
Dose 3 — Moderna
-
2021-11-20
Survey response — day 14, dose 3MedDRA: Burning sensation, Pruritus, Rash pruritic — Feeling: Good · Be unable to do your normal daily activitiesFree text: Random itching that migrates from palms to feet to shoulders, breast, midriff, fingers, toes. The itching usually creates a rash with itching and burning lasting 10-15 minutes. it subsides only to happen again randomly. Began 12 days after 3rd shotMedDRA releases: 2024-11 · check-in free text available
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2021-11-25
Survey response — day 21, dose 3MedDRA: Arthralgia, Immune system disorder, Pain, Pain in extremity, Pruritus, Self-medication — Feeling: Fair · Be unable to do your normal daily activitiesFree text: The itchy migrating flare ups continue. Zyrtec seems to help. But I'm also experiencing joint pain especially in my hips and it radiates down my legs. It too flares up. It feels very much like my immune system is hyperactive and is manifestingMedDRA releases: 2024-11 · check-in free text available
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2021-12-02
Survey response — day 28, dose 3MedDRA: Histamine intolerance, Office visit, Pruritus — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Still experiencing itch. Dermatologist said it's a histamine reaction and prescribed Zyrtec or Allegra daily which has helped. But without it the itchy flare ups reoccur.MedDRA releases: 2024-11 · check-in free text available
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2021-12-10
Survey response — day 35, dose 3MedDRA: Arthralgia, Myalgia, Neuralgia, Office visit, Pruritus, Sacral pain, Self-medication — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: In addition to the itch which is controlled by taking Allegra twice a day, I am having chronic muscle , joint pain in my left gluteus muscles and SI joint pain. It also creates sharp nerve pain down the side of my left leg. · Healthcare visit (other): Primary care and chiropracticMedDRA releases: 2024-11 · check-in free text available
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2021-12-10
Report sent to call center — day 35, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-12-10
- 2021-12-18
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-25 | Moderna | |
| 2 | 2021-04-21 | Moderna | No |
| 3 | 2021-11-04 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
Release 10 — day 14, dose 3
Symptoms: Random itching that migrates from palms to feet to shoulders, breast, midriff, fingers, toes. The itching usually creates a rash with itching and burning lasting 10-15 minutes. it subsides only to happen again randomly. Began 12 days after 3rd shot cut off by CDC
Release 10 — day 21, dose 3
Symptoms: The itchy migrating flare ups continue. Zyrtec seems to help. But I'm also experiencing joint pain especially in my hips and it radiates down my legs. It too flares up. It feels very much like my immune system is hyperactive and is manifesting
Release 10 — day 28, dose 3
Symptoms: Still experiencing itch. Dermatologist said it's a histamine reaction and prescribed Zyrtec or Allegra daily which has helped. But without it the itchy flare ups reoccur.
Release 10 — day 35, dose 3
Symptoms: In addition to the itch which is controlled by taking Allegra twice a day, I am having chronic muscle , joint pain in my left gluteus muscles and SI joint pain. It also creates sharp nerve pain down the side of my left leg.
Healthcare visit (other): Primary care and chiropractic
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 | Arthralgia | · | · | ✓ |
| SD | Burning sensation | · | · | ✓ |
| SD | Histamine intolerance | · | · | ✓ |
| SD | Immune system disorder | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Neuralgia | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pruritus | · | · | ✓ |
| SD | Rash pruritic | · | · | ✓ |
| SD | Sacral pain | · | · | ✓ |
| SD | Self-medication | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release