42F-12758-51516
3 vaccinations
3 coded responses
34 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 379 / TN
- Registered
- 2021-01-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-08
Dose 1 — Moderna
-
2021-01-09
Registered in v-safe
- 2021-01-09
- 2021-01-10
- 2021-01-11
-
2021-01-12
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain, Injection site swelling — Feeling: Good · Site: SwellingFree text: Swelling essentially gone; slight/mild tenderness still at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-13
- 2021-01-14
- 2021-01-15
- 2021-01-22
- 2021-01-29
- 2021-02-05
-
2021-02-10
Dose 2 — Moderna
-
2021-02-12
Survey response — days 1–6 daily, dose 2MedDRA: Injection site pain, Injection site swelling — Feeling: Good · Site: SwellingFree text: Swelling & tenderness around the injection site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-13
- 2021-02-14
- 2021-02-16
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-03-12
- 2021-03-17
- 2021-03-26
- 2021-05-14
- 2021-08-11
-
2021-10-24
Dose 3 — Moderna
-
2021-10-27
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Redness, Swelling, Itching · NoneAdult check-in
- 2021-10-28
- 2021-10-30
- 2021-10-31
- 2021-11-07
- 2021-11-14
- 2021-11-21
- 2021-11-28
- 2021-12-05
-
2022-01-23
Survey response — 3 months, dose 3MedDRA: Anxiety, Chest pain, Emergency care, Exposure to SARS-CoV-2, Paranasal sinus hypersecretion, SARS-CoV-2 test positive, Sinus congestion — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visitFree text: Symptoms: Sinus drainage and congestion similar to most years, but also chest pain that led to ER visit. No heart issues, but COVID-19 home test after came back positive. · Healthcare visit (other): ER was ER was for nonspecific chest pain, did not suspect COVID at the time, but suspected exposure at ER led to concern to get test.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-23
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
-
2022-01-24
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-04-24
- 2022-10-24
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-08 | Moderna | |
| 2 | 2021-02-10 | Moderna | |
| 3 | 2021-10-24 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Swelling essentially gone; slight/mild tenderness still at injection site
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Swelling & tenderness around the injection site.
Release 11 — 3 months, dose 3
Symptoms: Sinus drainage and congestion similar to most years, but also chest pain that led to ER visit. No heart issues, but COVID-19 home test after came back positive.
Healthcare visit (other): ER was ER was for nonspecific chest pain, did not suspect COVID at the time, but suspected exposure at ER led to concern to get test.
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 | Anxiety | · | · | ✓ |
| HCVO | Chest pain | · | · | ✓ |
| HCVO | Emergency care | · | · | ✓ |
| HCVO | Exposure to SARS-CoV-2 | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Paranasal sinus hypersecretion | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sinus congestion | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Injection site swelling | ✓ | ✓ | ✓ |
| SRO | Tenderness | ○ | ○ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release