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4FS-12588-74993

1 vaccination 1 coded response 4 check-ins 1 free-text entry 0 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
915 / CA
Registered
2021-07-04
Relationship
Adult relative or friend
Guardian
ZZU-51661-60540
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-07-01
    Dose 1 — Moderna
  2. 2021-07-04
    Registered in v-safe
  3. 2021-07-04
    Health check-in — days 1–6 daily, dose 1, dependent
    Feeling: Good · None
    Adult check-in
  4. 2021-07-05
    Health check-in — days 1–6 daily, dose 1, dependent
    Feeling: Good · None
    Adult check-in
  5. 2021-07-06
    Health check-in — days 1–6 daily, dose 1, dependent
    Feeling: Good · None
    Adult check-in
  6. 2021-07-08
    Survey response — day 7, dose 1, dependent
    MedDRA: Unevaluable event — Feeling: Poor · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do their normal daily activities
    Free text: I cant take this I wish I never got it
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-07-01Moderna No

Free text

Release 9 — day 7, dose 1, dependent

2021-07-08

Systemic reaction (other): I cant take this I wish I never got it

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

FieldPreferred term2021-092023-042024-11
SROUnevaluable event ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release