425-63784-39952
3 vaccinations
3 coded responses
4 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 995 / AK
- Registered
- 2021-04-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
A4S-64763-30617
Child or adolescent in my care · Male · 2021-11-05
Timeline
-
2021-02-26
Dose 1 — Moderna
-
2021-04-15
Registered in v-safe
-
2021-04-15
Dose 2 — Moderna
-
2021-04-17
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Chills, Joint pains, Fatigue or tiredness, Diarrhea · Be unable to work, Be unable to do your normal daily activitiesFree text: These occurred Friday 4/16MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-20
-
2021-07-17
Survey response — 3 months, dose 2MedDRA: Abortion spontaneous — Feeling: Poor · 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 visitFree text: MiscarriageMedDRA releases: 2024-11 · check-in free text available
-
2021-07-17
Report sent to call center — 3 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)
- 2021-07-23
-
2021-11-19
Dose 3 — Moderna
-
2021-11-20
Survey response — days 1–6 daily, dose 3MedDRA: Dizziness — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesFree text: DizzinessMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-26 | Moderna | |
| 2 | 2021-04-15 | Moderna | |
| 3 | 2021-11-19 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-07-17 | Unsuccessful |
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): These occurred Friday 4/16
Release 9 — 3 months, dose 2
Symptoms: Miscarriage
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Dizziness
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 | Abortion spontaneous | · | · | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Dizziness | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release