4F9-66980-71379
4 vaccinations
3 coded responses
27 check-ins
3 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 024 / MA
- Registered
- 2021-02-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
K6W-12308-56427
Child or adolescent in my care · Male · 2022-06-25
Timeline
-
2021-01-25
Dose 1 — Moderna
-
2021-02-01
Registered in v-safe
-
2021-02-01
Health check-in — day 7, dose 1Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness, Nausea, DiarrheaAdult check-in
- 2021-02-08
- 2021-02-15
-
2021-02-22
Dose 2 — Moderna
- 2021-02-22
-
2021-02-24
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Headache, DiarrheaAdult check-in
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-08
- 2021-03-15
- 2021-03-22
- 2021-03-29
- 2021-04-05
- 2021-05-24
- 2021-08-23
-
2021-08-30
Dose 3 — Moderna
- 2021-11-29
- 2022-02-28
-
2022-09-01
Survey response — 12 months, dose 3MedDRA: Cough, Rhinorrhoea — Feeling: Fair · Be unable to work or attend schoolFree text: Runny nose and coughing.MedDRA releases: 2024-11 · check-in free text available
-
2022-09-14
Dose 4 — Moderna
- 2022-09-22
-
2022-09-28
Survey response — day 14, dose 4MedDRA: Abdominal pain, Chills, Diverticulitis, Nausea, Pyrexia — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: I was diagnosed with diverticulitis and experienced low-grade fever, chills, abdominal pain, and nausea related to that.MedDRA releases: 2024-11 · check-in free text available
-
2022-09-28
Report sent to call center — day 14, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2022-09-29
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-10-05
- 2022-10-12
- 2022-10-19
- 2022-10-26
-
2022-12-14
Survey response — 3 months, dose 4MedDRA: Diverticulitis, Pregnancy — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: I became pregnant. I had diverticulitis.MedDRA releases: 2024-11 · check-in free text available
-
2022-12-14
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2022-12-15
- 2023-03-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-25 | Moderna | |
| 2 | 2021-02-22 | Moderna | |
| 3 | 2021-08-30 | Moderna | No |
| 4 | 2022-09-14 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-09-28 | Successful 2022-09-29 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-12-14 | Unsuccessful |
Free text
Release 12 — 12 months, dose 3
Symptoms: Runny nose and coughing.
Release 12 — day 14, dose 4
Symptoms: I was diagnosed with diverticulitis and experienced low-grade fever, chills, abdominal pain, and nausea related to that.
Release 12 — 3 months, dose 4
Symptoms: I became pregnant. I had diverticulitis.
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 | Abdominal pain | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Diverticulitis | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Pregnancy | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release