4JM-33425-78612
4 vaccinations
5 coded responses
39 check-ins
4 free-text entries
1 call case
- Sex
- —
- Age at first dose
- 56-60
- ZIP prefix
- 982 / WA
- Registered
- 2021-01-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-28
Registered in v-safe
-
2021-01-28
Dose 1 — Moderna
- 2021-01-28
-
2021-01-29
Health check-in — days 1–6 daily, dose 1Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
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2021-01-30
Survey response — days 1–6 daily, dose 1MedDRA: Erythema, Pruritus, Urticaria — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Hives and redness around both ankles and feet started about 8 hours after injection. Slight spread to thighs and few hives on lower back. Started to subside day two, but itchiness and hives remain on ankles and heals.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-31
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus, Rash, Rash erythematous, Rash pruritic, Urticaria — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Red itchy rash with hives continued on lower leg, ankles, feet.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-02
Survey response — days 1–6 daily, dose 1MedDRA: Medical counselling — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Previous report of rash not due to covid vaccine, realized it was an allergic reaction to an antibiotic that i had been taking. This info in consultation with both the doc prescribing the antibiotic and my internal med doc.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-03
Health check-in — days 1–6 daily, dose 1Feeling: Poor · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-02-11
- 2021-02-18
-
2021-02-25
Dose 2 — Moderna
- 2021-02-25
-
2021-02-26
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Headache, Joint painsAdult check-in
- 2021-02-27
- 2021-02-28
-
2021-03-01
Health check-in — days 1–6 daily, dose 2Feeling: Good · Headache, Muscle or body achesAdult check-in
-
2021-03-02
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-03
- 2021-03-06
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-03
- 2021-04-08
- 2021-05-27
-
2021-10-24
Dose 3 — Moderna
- 2021-10-25
- 2021-10-26
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-07
- 2021-11-16
- 2021-11-21
- 2021-11-28
- 2021-12-05
-
2022-04-14
Dose 4 — Moderna
- 2022-04-24
- 2022-05-14
-
2022-05-30
Survey response — day 42, dose 4MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: FairFree text: Sore throat, congestionMedDRA releases: 2024-11 · check-in free text available
- 2022-07-14
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2023-04-14
Survey response — 12 months, dose 4MedDRA: COVID-19, Emergency care — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationMedDRA releases: 2024-11
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2023-04-14
Report sent to call center — 12 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2023-04-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-28 | Moderna | |
| 2 | 2021-02-25 | Moderna | |
| 3 | 2021-10-24 | Moderna | No |
| 4 | 2022-04-14 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Hives and redness around both ankles and feet started about 8 hours after injection. Slight spread to thighs and few hives on lower back. Started to subside day two, but itchiness and hives remain on ankles and heals.
Systemic reaction (other): Red itchy rash with hives continued on lower leg, ankles, feet.
Systemic reaction (other): Previous report of rash not due to covid vaccine, realized it was an allergic reaction to an antibiotic that i had been taking. This info in consultation with both the doc prescribing the antibiotic and my internal med doc.
Release 11 — day 42, dose 4
Symptoms: Sore throat, congestion
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 | Emergency care | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Medical counselling | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | · | ✓ |
| SRO | Rash erythematous | ✓ | ✓ | ✓ |
| SRO | Rash pruritic | ✓ | · | ✓ |
| SRO | Urticaria | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release