46B-11279-11020
5 vaccinations
4 coded responses
37 check-ins
3 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 349 / FL
- Registered
- 2021-03-06
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-06
Registered in v-safe
-
2021-03-06
Dose 1 — Moderna
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-20
- 2021-03-27
-
2021-04-02
Dose 2 — Moderna
- 2021-04-03
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-08
- 2021-04-09
-
2021-04-16
Survey response — day 14, dose 2MedDRA: Injection site erythema, Injection site pruritus — Feeling: GoodFree text: Last weekend, the shot area was very-slightly red & very-slightly itchy; which lasted about 2 days only. I was not concerned at all & mention it because it was different than the usual nothing.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-23
- 2021-04-30
- 2021-05-07
- 2021-05-14
- 2021-07-03
-
2021-09-03
Dose 3 — Moderna
-
2021-10-01
Survey response — 6 months, dose 2MedDRA: Chills, Decreased appetite, Laboratory test abnormal, Lethargy, Pre-existing disease, Pyrexia — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Fever, chills, lethargy, no appetite 9/9 - 9/20/21 - determined as possible reaction to 9/3/21 Covid booster. Had no antibodies from vacc 1 & 2 after 4 months according to Leukemia Society antibody study lab test. On Chemo during vacc 1 & 2.MedDRA releases: 2024-11 · check-in free text available
-
2021-10-01
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-10-05
-
2021-10-05
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-12-03
- 2022-03-04
-
2022-04-09
Dose 4 — Moderna
-
2022-04-14
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Good · Site: ItchingFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-04-15
- 2022-04-16
- 2022-04-23
- 2022-04-30
- 2022-05-07
- 2022-05-14
- 2022-05-21
- 2022-07-09
- 2022-10-08
-
2022-11-28
Dose 5 — Moderna
-
2023-04-09
Survey response — 12 months, dose 4MedDRA: Adverse drug reaction, Bronchitis, Diarrhoea, Office visit, Rhinovirus infection, Urinary tract infection — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11
-
2023-04-09
Report sent to call center — 12 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2023-04-10
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-05-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-06 | Moderna | |
| 2 | 2021-04-02 | Moderna | |
| 3 | 2021-09-03 | Moderna | No |
| 4 | 2022-04-09 | Moderna | No |
| 5 | 2022-11-28 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 7 — day 14, dose 2
Symptoms: Last weekend, the shot area was very-slightly red & very-slightly itchy; which lasted about 2 days only. I was not concerned at all & mention it because it was different than the usual nothing.
Release 9 — 6 months, dose 2
Symptoms: Fever, chills, lethargy, no appetite 9/9 - 9/20/21 - determined as possible reaction to 9/3/21 Covid booster. Had no antibodies from vacc 1 & 2 after 4 months according to Leukemia Society antibody study lab test. On Chemo during vacc 1 & 2.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): No
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 | Adverse drug reaction | · | · | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Decreased appetite | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Injection site erythema | ✓ | ✓ | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Laboratory test abnormal | · | · | ✓ |
| SD | Lethargy | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinovirus infection | · | · | ✓ |
| SD | Urinary tract infection | · | · | ✓ |
| SRO | No adverse event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release