42V-23378-51567
4 vaccinations
3 coded responses
6 check-ins
3 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 935 / CA
- Registered
- 2021-11-05
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Registered dependents
A9B-93132-73158
Child or adolescent in my care · Male · 2021-11-05
Timeline
-
2021-02-04
Dose 1 — Moderna
-
2021-03-04
Dose 2 — Moderna
-
2021-11-03
Dose 3 — Pfizer-BioNTech
-
2021-11-05
Registered in v-safe
-
2021-11-05
Survey response — days 1–6 daily, dose 3MedDRA: Axillary pain — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body achesFree text: dolor en la axilaMedDRA releases: 2024-11 · check-in free text available
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2021-11-06
Survey response — days 1–6 daily, dose 3MedDRA: Axillary pain, Pain in extremity — Feeling: Fair · Site: Pain · Muscle or body achesFree text: Dolor en el brazo de y la parte de la axilaMedDRA releases: 2024-11 · check-in free text available
-
2021-11-07
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Muscle or body achesAdult check-in
-
2021-11-17
Survey response — day 14, dose 3MedDRA: Dizziness, Head discomfort, Oropharyngeal pain, Pain — Feeling: Fair · Be unable to do your normal daily activitiesFree text: he estado teniendo mucho dolor de cuerpo y un poco mareada como la cabeza grande, dolor se gargantaMedDRA releases: 2024-11 · check-in free text available
- 2021-12-08
-
2022-10-06
Dose 4 — Pfizer-BioNTech
- 2022-10-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Moderna | No |
| 2 | 2021-03-04 | Moderna | No |
| 3 | 2021-11-03 | Pfizer-BioNTech | No |
| 4 | 2022-10-06 | Pfizer-BioNTech | No |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): dolor en la axila
Systemic reaction (other): Dolor en el brazo de y la parte de la axila
Release 10 — day 14, dose 3
Symptoms: he estado teniendo mucho dolor de cuerpo y un poco mareada como la cabeza grande, dolor se garganta
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 | Dizziness | · | · | ✓ |
| SD | Head discomfort | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SRO | Axillary pain | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release