4JV-18102-12237
3 vaccinations
7 coded responses
14 check-ins
7 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 808 / CO
- Registered
- 2021-05-15
- Relationship
- Self
- Race
- Other
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-04-13
Dose 1 — Moderna
-
2021-05-12
Dose 2 — Moderna
-
2021-05-15
Registered in v-safe
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2021-05-15
Survey response — days 1–6 daily, dose 2MedDRA: Dehydration — Feeling: FairFree text: Very dehydrated, not normal for meMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-16
Survey response — days 1–6 daily, dose 2MedDRA: Dehydration — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessFree text: Still feeling dehydrated, not as much as yesterday. No normal reason for dehydration.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-18
Survey response — days 1–6 daily, dose 2MedDRA: Chills, Lip dry, Oral discomfort, Oral herpes — Feeling: GoodFree text: Yesterday was better, noticed lips still very dry and have had a burning sensation and developed cold soars I never knew I had. Checked temperature last 2 days between 98.3-98.4. Never felt chills or fever. Feel okay today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-19
Survey response — day 7, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: My lips are still recovering (sounds strange), no other symptoms.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-26
- 2021-06-02
- 2021-06-09
- 2021-06-18
- 2021-06-23
- 2021-08-11
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2021-11-10
Survey response — 6 months, dose 2MedDRA: Chest pain, Oropharyngeal pain, Pharyngeal swelling, Pyrexia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Burning in the chest, sore throat, fever, swollen feeling in the throatMedDRA releases: 2024-11 · check-in free text available
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2021-11-26
Dose 3 — Moderna
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2022-05-12
Survey response — 12 months, dose 2MedDRA: Office visit, Oropharyngeal pain, Swelling — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: It is not "new." I honestly don't think it has anything to do with COVID For the last 2 years I have had a, at first occasional, now constant sore throat with a swollen feeling in my throat. I'm seeing specialist, but they are still unsure cause · Healthcare visit (other): Primary care Physician and specialistMedDRA releases: 2024-11 · check-in free text available
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2022-05-12
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-05-13
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2022-05-13
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-05-27
Survey response — 6 months, dose 3MedDRA: No adverse event — Feeling: FairFree text: I HAVE NOT experienced any symptoms, but both my husband and son are sick. They both tested negative to a 15 minute self test. If they do not feel better by tomorrow I am asking them to go to our local COVID testing site so it can be sent in.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-26
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-13 | Moderna | |
| 2 | 2021-05-12 | Moderna | |
| 3 | 2021-11-26 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Very dehydrated, not normal for me
Systemic reaction (other): Still feeling dehydrated, not as much as yesterday. No normal reason for dehydration.
Systemic reaction (other): Yesterday was better, noticed lips still very dry and have had a burning sensation and developed cold soars I never knew I had. Checked temperature last 2 days between 98.3-98.4. Never felt chills or fever. Feel okay today.
Release 8 — day 7, dose 2
Systemic reaction (other): My lips are still recovering (sounds strange), no other symptoms.
Release 10 — 6 months, dose 2
Symptoms: Burning in the chest, sore throat, fever, swollen feeling in the throat
Release 11 — 12 months, dose 2
Symptoms: It is not "new." I honestly don't think it has anything to do with COVID For the last 2 years I have had a, at first occasional, now constant sore throat with a swollen feeling in my throat. I'm seeing specialist, but they are still unsure cause
Healthcare visit (other): Primary care Physician and specialist
Release 11 — 6 months, dose 3
Symptoms: I HAVE NOT experienced any symptoms, but both my husband and son are sick. They both tested negative to a 15 minute self test. If they do not feel better by tomorrow I am asking them to go to our local COVID testing site so it can be sent in.
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 | Office visit | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | No adverse event | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pharyngeal swelling | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Swelling | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Dehydration | ✓ | ✓ | ✓ |
| SRO | Lip dry | ✓ | ✓ | ✓ |
| SRO | Oral discomfort | ✓ | ✓ | ✓ |
| SRO | Oral herpes | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release