4MJ-25860-96913
5 vaccinations
7 coded responses
30 check-ins
7 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 981 / WA
- Registered
- 2021-02-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-16
Registered in v-safe
-
2021-02-16
Dose 1 — Moderna
- 2021-02-16
- 2021-02-17
-
2021-02-18
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-02-19
Survey response — days 1–6 daily, dose 1MedDRA: Nasal congestion, Sinus arrhythmia, Sinus disorder — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessFree text: Stuffy nose, sinusMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-24
- 2021-03-02
- 2021-03-09
-
2021-03-16
Dose 2 — Moderna
-
2021-03-16
Health check-in — day 0, dose 2Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-17
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Muscle or body aches, Fatigue or tirednessFree text: Armpit, neck, lower back painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-18
-
2021-03-19
Survey response — days 1–6 daily, dose 2MedDRA: Injection site rash — Feeling: Good · Site: Redness · Rash, not including the immediate area around the injection siteFree text: Rash from the injection site down the front of my arm to my elbowMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-21
Survey response — days 1–6 daily, dose 2MedDRA: Rash — Feeling: Fair · Site: Itching · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection siteFree text: Front arm rash recedingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-22
- 2021-03-23
-
2021-09-14
Survey response — 6 months, dose 2MedDRA: Office visit, Polymyalgia rheumatica, Thrombosis — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: I developed Polymyalgia Rheumatica in March 2021 and am taking 5mg prednisone. In August 2021 I developed 2 blood clots in my left leg and am taking Xeralto (blood thinner). · Healthcare visit (other): Primary physician and then referrals to a rheumatologist and then a hematologist.MedDRA releases: 2024-11 · check-in free text available
-
2021-09-14
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-17
-
2021-09-17
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-11-14
Dose 3 — Moderna
- 2022-03-16
-
2022-04-19
Dose 4 — Pfizer-BioNTech
-
2022-04-21
Survey response — days 1–6 daily, dose 4MedDRA: Lymph node pain — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches · Be unable to do your normal daily activitiesFree text: Sore lymph node under injection siteMedDRA releases: 2024-11 · check-in free text available
-
2022-04-23
Survey response — days 1–6 daily, dose 4MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · Site: Pain · Muscle or body achesFree text: Sore and swollen lymph nodes under injection siteMedDRA releases: 2024-11 · check-in free text available
- 2022-04-24
- 2022-04-25
- 2022-04-28
- 2022-05-03
- 2022-05-10
- 2022-05-27
- 2022-05-31
- 2022-07-21
-
2023-01-05
Dose 5 — Pfizer-BioNTech
- 2023-04-20
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-16 | Moderna | |
| 2 | 2021-03-16 | Moderna | |
| 3 | 2021-11-14 | Moderna | No |
| 4 | 2022-04-19 | Pfizer-BioNTech | No |
| 5 | 2023-01-05 | Pfizer-BioNTech | No |
Call center
1 call center case
1 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Stuffy nose, sinus
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Armpit, neck, lower back pain
Systemic reaction (other): Rash from the injection site down the front of my arm to my elbow
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Front arm rash receding
Release 9 — 6 months, dose 2
Symptoms: I developed Polymyalgia Rheumatica in March 2021 and am taking 5mg prednisone. In August 2021 I developed 2 blood clots in my left leg and am taking Xeralto (blood thinner).
Healthcare visit (other): Primary physician and then referrals to a rheumatologist and then a hematologist.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Sore lymph node under injection site
Systemic reaction (other): Sore and swollen lymph nodes under injection site
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 | Polymyalgia rheumatica | · | · | ✓ |
| SD | Thrombosis | · | · | ✓ |
| SRO | Injection site rash | ✓ | ✓ | ✓ |
| SRO | Lymph node pain | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
| SRO | Nasal congestion | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Sinus arrhythmia | ○ | ✓ | ○ |
| SRO | Sinus disorder | ✓ | · | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release