4MM-13772-19373
4 vaccinations
7 coded responses
46 check-ins
7 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 857 / AZ
- Registered
- 2021-03-09
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Registered dependents
EM7-22718-03464
Child or adolescent in my care · Male · 2021-11-11
L6N-13083-54707
Child or adolescent in my care · Male · 2021-11-11
WXZ-53477-18160
Child or adolescent in my care · Female · 2021-11-11
Timeline
-
2021-03-09
Registered in v-safe
-
2021-03-09
Dose 1 — Moderna
- 2021-03-09
-
2021-03-10
Survey response — days 1–6 daily, dose 1MedDRA: COVID-19 — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Covid Dec 8, 2020. Still on oxygen bc pneumonia I didn't know hadn't resolved. Sats are 93.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-11
Survey response — days 1–6 daily, dose 1MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: I feel much better than yesterday!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-24
- 2021-03-30
-
2021-04-06
Dose 2 — Moderna
- 2021-04-06
-
2021-04-08
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tirednessFree text: I had these symptoms on the 2nd day, but missed reporting them. Better today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-09
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Itching · Muscle or body achesAdult check-in
-
2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2021-04-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-04-12
-
2021-04-15
Health check-in — day 7, dose 2Feeling: Good · Headache, Muscle or body aches, DiarrheaAdult check-in
- 2021-04-21
- 2021-04-27
-
2021-05-04
Survey response — day 28, dose 2MedDRA: Cough, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: FairFree text: Sore thrust, cough, nasal congestion. I think this is seasonal allergies, probably unrelated. Concerned, I took a COVID-19 test that was negative.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-11
- 2021-05-18
- 2021-07-06
-
2021-09-05
Dose 3 — Moderna
- 2021-09-05
-
2021-09-06
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
- 2021-09-07
-
2021-09-08
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
-
2021-09-09
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body achesFree text: The house is on fire today.MedDRA releases: 2024-11 · check-in free text available
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2021-09-10
Survey response — days 1–6 daily, dose 3MedDRA: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Injection site warmth, Medical counselling, Vaccination error — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tirednessFree text: Yesterday I copy/pasted the wrong text here. At injection site, arm is swollen, redness, painful & hot to the touch, but itching. Area about the size of a large orange. A pharmacist & RN believe it's probably theway shotwas administered. Now clearingMedDRA releases: 2024-11 · check-in free text available
-
2021-09-11
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Redness, Itching · NoneAdult check-in
- 2021-09-12
- 2021-09-19
- 2021-09-26
- 2021-10-03
- 2021-10-10
- 2021-10-17
- 2021-12-07
- 2022-03-08
-
2022-03-29
Dose 4 — Moderna
- 2022-04-14
-
2022-04-21
Survey response — day 21, dose 4MedDRA: Seizure — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Sadly I had another seizure episode -- unrelated to Covid.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-21
Report sent to call center — day 21, dose 4Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2022-04-26
-
2022-04-27
Call successfulNot applicable - Accidental Reporting
- 2022-05-03
- 2022-05-10
- 2022-06-28
- 2022-09-27
- 2023-03-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-09 | Moderna | |
| 2 | 2021-04-06 | Moderna | |
| 3 | 2021-09-05 | Moderna | No |
| 4 | 2022-03-29 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Covid Dec 8, 2020. Still on oxygen bc pneumonia I didn't know hadn't resolved. Sats are 93.
Systemic reaction (other): I feel much better than yesterday!
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): I had these symptoms on the 2nd day, but missed reporting them. Better today.
Release 8 — day 28, dose 2
Symptoms: Sore thrust, cough, nasal congestion. I think this is seasonal allergies, probably unrelated. Concerned, I took a COVID-19 test that was negative.
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): The house is on fire today.
Systemic reaction (other): Yesterday I copy/pasted the wrong text here. At injection site, arm is swollen, redness, painful & hot to the touch, but itching. Area about the size of a large orange. A pharmacist & RN believe it's probably theway shotwas administered. Now clearing cut off by CDC
Release 11 — day 21, dose 4
Symptoms: Sadly I had another seizure episode -- unrelated to Covid.
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 | Cough | ✓ | ✓ | ✓ |
| SD | Nasal congestion | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SD | Seizure | · | · | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | COVID-19 | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | · | · | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Injection site pruritus | · | · | ✓ |
| SRO | Injection site swelling | · | · | ✓ |
| SRO | Injection site warmth | · | · | ✓ |
| SRO | Medical counselling | · | · | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
| SRO | Vaccination error | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release