4QJ-16976-55149
3 vaccinations
6 coded responses
19 check-ins
6 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 21-25
- ZIP prefix
- 194 / PA
- Registered
- 2021-04-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-02
Dose 1 — Moderna
-
2021-04-10
Registered in v-safe
- 2021-04-10
- 2021-04-16
- 2021-04-25
- 2021-04-30
-
2021-05-03
Dose 2 — Moderna
-
2021-05-04
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-05-05
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Headache, Fatigue or tiredness, NauseaAdult check-in
- 2021-05-08
- 2021-05-12
- 2021-11-01
-
2021-12-18
Dose 3 — Moderna
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2021-12-21
Survey response — days 1–6 daily, dose 3MedDRA: Aphthous ulcer, Lymphadenopathy, Mouth ulceration, Stomatitis — Feeling: Good · Site: PainFree text: Swollen lymph node in neck on side of injection. Ulcer/canker sore in mouth cheek on side of injection. Both appeared day after shot.MedDRA releases: 2024-11 · check-in free text available
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2021-12-22
Survey response — days 1–6 daily, dose 3MedDRA: Lymphadenopathy, Mouth ulceration — Feeling: GoodFree text: Lymph node swelling still, mouth ulcer still.MedDRA releases: 2024-11 · check-in free text available
-
2021-12-23
Survey response — days 1–6 daily, dose 3MedDRA: Aphthous ulcer, Lymph node pain — Feeling: GoodFree text: Tender lymph node, mouth canker sore still remainsMedDRA releases: 2024-11 · check-in free text available
- 2021-12-24
- 2021-12-27
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2022-01-04
Survey response — day 14, dose 3MedDRA: Urticaria — Feeling: GoodFree text: Hives on various parts of my body. Unsure if related to vaccine.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-15
Survey response — day 28, dose 3MedDRA: Urticaria — Feeling: GoodFree text: Hives still occurring. Started one week after booster.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-31
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2022-03-19
Survey response — 3 months, dose 3MedDRA: Urticaria — Feeling: GoodFree text: Hives on my body since 1.5 weeks after vaccination. Relief only by allergy medication.MedDRA releases: 2024-11 · check-in free text available
- 2022-12-18
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-02 | Moderna | |
| 2 | 2021-05-03 | Moderna | |
| 3 | 2021-12-18 | Moderna | No |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Swollen lymph node in neck on side of injection. Ulcer/canker sore in mouth cheek on side of injection. Both appeared day after shot.
Systemic reaction (other): Lymph node swelling still, mouth ulcer still.
Systemic reaction (other): Tender lymph node, mouth canker sore still remains
Release 10 — day 14, dose 3
Symptoms: Hives on various parts of my body. Unsure if related to vaccine.
Release 10 — day 28, dose 3
Symptoms: Hives still occurring. Started one week after booster.
Release 11 — 3 months, dose 3
Symptoms: Hives on my body since 1.5 weeks after vaccination. Relief only by allergy medication.
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 | Urticaria | · | · | ✓ |
| SRO | Aphthous ulcer | · | · | ✓ |
| SRO | Lymph node pain | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
| SRO | Mouth ulceration | · | · | ✓ |
| SRO | Stomatitis | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release