484-51353-92871
2 vaccinations
2 coded responses
5 check-ins
2 free-text entries
1 call case
- Sex
- —
- Age at first dose
- 41-45
- ZIP prefix
- 856 / AZ
- Registered
- 2021-01-25
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-01-25
Registered in v-safe
-
2021-01-25
Dose 1 — Moderna
-
2021-01-25
Survey response — day 0, dose 1MedDRA: Injection site pain — Feeling: Good · Muscle or body achesFree text: Sore at the injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-29
- 2021-02-03
- 2021-02-10
-
2021-02-15
Survey response — day 21, dose 1MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Be unable to workFree text: Tested positive for COVIDMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-15
-
2021-02-22
Dose 2 — Moderna
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-25 | Moderna | |
| 2 | 2021-02-22 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-02-15 | priority 2/3 |
Free text
Release 2 — day 0, dose 1
Systemic reaction (other): Sore at the injection site
Release 4 — day 21, dose 1
Symptoms: Tested positive for COVID
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 | SARS-CoV-2 test positive | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release