485-55368-81463
4 vaccinations
4 coded responses
17 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 614 / IL
- Registered
- 2021-01-25
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
LCJ-70468-22674
Child or adolescent in my care · Female · 2022-07-27
VWG-23437-71598
Child or adolescent in my care · Female · 2022-07-27
Timeline
-
2020-12-23
Dose 1 — Moderna
-
2021-01-21
Dose 2 — Moderna
-
2021-01-25
Registered in v-safe
- 2021-01-25
- 2021-01-26
-
2021-01-27
Survey response — days 1–6 daily, dose 2MedDRA: Lymphadenopathy, Nasal congestion, Oropharyngeal pain, Rhinorrhoea — Feeling: Fair · Chills, Headache, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Nasal congestion, rhinorrhea, neck lymphadenopathy, sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-27
Report sent to call center — days 1–6 daily, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-01-30
Health check-in — day 7, dose 2Feeling: Fair · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-02-04
- 2021-02-11
- 2021-02-18
- 2021-02-25
- 2021-04-12
-
2021-04-12
Call successfulDoes not wish to fill out VAERS report
- 2021-04-24
-
2021-07-22
Survey response — 6 months, dose 2MedDRA: Gastroenteritis, Viral tonsillitis — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Viral tonsillitis, gastroenteritisMedDRA releases: 2024-11 · check-in free text available
-
2021-07-22
Report sent to call center — 6 months, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-07-23
-
2021-07-26
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-11-06
Dose 3 — Moderna
-
2022-01-21
Survey response — 12 months, dose 2MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend schoolFree text: Tested positive for COVID todayMedDRA releases: 2024-11 · check-in free text available
-
2022-05-07
Survey response — 6 months, dose 3MedDRA: Epistaxis, Nasal septum disorder — Feeling: GoodFree text: Recurrent epistaxis, nasal septum abnormalityMedDRA releases: 2024-11 · check-in free text available
-
2022-06-20
Dose 4 — Moderna
- 2022-07-27
- 2022-08-01
- 2022-09-19
- 2022-12-21
- 2023-06-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-23 | Moderna | |
| 2 | 2021-01-21 | Moderna | |
| 3 | 2021-11-06 | Moderna | No |
| 4 | 2022-06-20 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-01-27 | Successful 2021-04-12 |
Does not wish to fill out VAERS report |
| 2021-07-22 | Successful 2021-07-26 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 2 — days 1–6 daily, dose 2
Systemic reaction (other): Nasal congestion, rhinorrhea, neck lymphadenopathy, sore throat
Release 9 — 6 months, dose 2
Symptoms: Viral tonsillitis, gastroenteritis
Release 11 — 12 months, dose 2
Symptoms: Tested positive for COVID today
Release 11 — 6 months, dose 3
Symptoms: Recurrent epistaxis, nasal septum abnormality
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 | Epistaxis | · | · | ✓ |
| SD | Gastroenteritis | · | · | ✓ |
| SD | Nasal septum disorder | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Viral tonsillitis | · | · | ✓ |
| SRO | Lymphadenopathy | ✓ | ✓ | ✓ |
| SRO | Nasal congestion | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release