4QV-35788-52196
4 vaccinations
9 coded responses
49 check-ins
9 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 864 / AZ
- Registered
- 2021-02-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Registered dependents
66B-17386-20844
Adult relative or friend · Male · 2022-04-20
Timeline
-
2021-02-04
Registered in v-safe
-
2021-02-04
Dose 1 — Moderna
- 2021-02-04
-
2021-02-05
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue — Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Extreme fatigue at 24hrs post vaccine. Rested 1 he & fine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-10
- 2021-02-11
- 2021-02-18
- 2021-02-25
-
2021-03-04
Dose 2 — Moderna
- 2021-03-04
-
2021-03-05
Survey response — days 1–6 daily, dose 2MedDRA: Cough — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Loose coughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-06
Survey response — days 1–6 daily, dose 2MedDRA: Cough — Feeling: Good · Site: Redness, Swelling, ItchingFree text: Cough lessened by 50%+MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-07
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Itching · Headache · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-08
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-09
Survey response — days 1–6 daily, dose 2MedDRA: Abdominal discomfort — Feeling: Good · Site: Itching · FeverFree text: Slight stomach upset since day 2MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-10
- 2021-03-11
- 2021-03-18
- 2021-03-25
-
2021-04-01
Survey response — day 28, dose 2MedDRA: Skin sensitisation — Feeling: FairFree text: Skin extremely sensitive to touch inner thigh one day and top of toes same leg next day.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-08
- 2021-04-15
- 2021-06-03
-
2021-09-02
Survey response — 6 months, dose 2MedDRA: Sinusitis — Feeling: GoodFree text: Sinus infection with antibiotics prescribedMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-10-23
Dose 3 — Moderna
-
2021-10-26
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain, Redness, Swelling · Fever · Headache, Fatigue or tirednessAdult check-in
-
2021-10-27
Survey response — days 1–6 daily, dose 3MedDRA: Breast tenderness, Contusion, Tenderness — Feeling: Good · Fever · Fatigue or tirednessFree text: Unexplained bruises with tenderness left breast (1") and left upper thigh (1 1/2 x 2") noticed yesterday morning upon awakening.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-11-06
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2021-11-13
Survey response — day 21, dose 3MedDRA: Swelling, Tenderness — Feeling: GoodFree text: Another unexplainable tenderness and small swelling on lt. lower leg. No visible bruise. Size of nickel yesterday but more like dime today. Blood vessel that runs across more visible yesterday but not today.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-20
- 2021-11-27
- 2021-12-04
- 2022-01-22
-
2022-04-19
Dose 4 — Moderna
- 2022-04-20
- 2022-04-22
- 2022-04-23
- 2022-04-24
- 2022-04-25
- 2022-04-26
- 2022-05-03
- 2022-05-10
- 2022-05-17
- 2022-05-24
- 2022-05-31
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2022-07-19
Survey response — 3 months, dose 4MedDRA: Cough, Musculoskeletal chest pain, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Ache/pain to rt. rib area (front, side, and back). Appt with doc Aug 18. Started in April but just now remembered I should mention it to you. Thought it was lacerated muscle from coughing in April. · Healthcare visit (other): MD in AugustMedDRA releases: 2024-11 · check-in free text available
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2022-07-19
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-07-20
-
2022-07-20
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-10-19
- 2023-04-21
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Moderna | |
| 2 | 2021-03-04 | Moderna | |
| 3 | 2021-10-23 | Moderna | No |
| 4 | 2022-04-19 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Extreme fatigue at 24hrs post vaccine. Rested 1 he & fine.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Loose cough
Systemic reaction (other): Cough lessened by 50%+
Systemic reaction (other): Slight stomach upset since day 2
Release 6 — day 28, dose 2
Symptoms: Skin extremely sensitive to touch inner thigh one day and top of toes same leg next day.
Release 9 — 6 months, dose 2
Symptoms: Sinus infection with antibiotics prescribed
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Unexplained bruises with tenderness left breast (1") and left upper thigh (1 1/2 x 2") noticed yesterday morning upon awakening.
Release 10 — day 21, dose 3
Symptoms: Another unexplainable tenderness and small swelling on lt. lower leg. No visible bruise. Size of nickel yesterday but more like dime today. Blood vessel that runs across more visible yesterday but not today.
Release 12 — 3 months, dose 4
Symptoms: Ache/pain to rt. rib area (front, side, and back). Appt with doc Aug 18. Started in April but just now remembered I should mention it to you. Thought it was lacerated muscle from coughing in April.
Healthcare visit (other): MD in August
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 | Unevaluable event | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Musculoskeletal chest pain | · | · | ✓ |
| SD | Sinusitis | ✓ | · | ✓ |
| SD | Skin sensitisation | ✓ | ✓ | ✓ |
| SD | Swelling | · | · | ✓ |
| SD | Tenderness | · | · | ✓ |
| SRO | Abdominal discomfort | ✓ | ✓ | ✓ |
| SRO | Breast tenderness | · | · | ✓ |
| SRO | Contusion | · | · | ✓ |
| SRO | Cough | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Tenderness | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release