4RN-33069-61048
5 vaccinations
3 coded responses
56 check-ins
3 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 713 / LA
- Registered
- 2021-01-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-01-01
Registered in v-safe
-
2021-01-01
Dose 1 — Moderna
- 2021-01-01
-
2021-01-02
Survey response — days 1–6 daily, dose 1MedDRA: Asthenia, Diarrhoea, Fatigue, Food poisoning, Nausea, Vomiting — Feeling: Poor · Site: Pain · Headache, Nausea, Vomiting, Diarrhea · Be unable to do your normal daily activitiesFree text: I think that I came down with food poisoning. I ate some greens that had to have been 3 weeks in the fridge. Within 15 minutes I became nauseated, then vomiting and diarrhea.Lasted from around 11pm til 6 am when everything was finally out of my stomach. Other than feeling weak and tired, I am feeling ok now. My symptoms when I had them were severe. Now I am good. The food was spoiled.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-02
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities1 call case(s)
- 2021-01-03
- 2021-01-04
- 2021-01-06
- 2021-01-07
- 2021-01-08
- 2021-01-15
- 2021-01-22
-
2021-01-28
Dose 2 — Moderna
-
2021-01-29
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-01-30
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness · HeadacheAdult check-in
-
2021-02-01
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-02-02
-
2021-02-03
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Chills, Headache · Be unable to do your normal daily activitiesAdult check-in
- 2021-02-04
- 2021-02-11
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-03-11
- 2021-04-29
- 2021-07-29
-
2021-11-05
Dose 3 — Moderna
- 2021-11-06
- 2021-11-07
- 2021-11-08
- 2021-11-09
- 2021-11-11
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
-
2021-12-17
Survey response — day 42, dose 3MedDRA: Thrombosis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Blood clot in lower legMedDRA releases: 2024-11 · check-in free text available
-
2021-12-17
Report sent to call center — day 42, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2021-12-21
Call successfulCompleted over the phone
-
2022-02-04
Survey response — 3 months, dose 3MedDRA: Arterial disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Entrapment of popliteal arteryMedDRA releases: 2024-11 · check-in free text available
-
2022-02-04
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-02-08
Call successfulDoes not wish to fill out VAERS report
-
2022-05-04
Dose 4 — Moderna
- 2022-05-04
-
2022-05-05
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Swelling · HeadacheAdult check-in
- 2022-05-06
-
2022-05-07
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-05-08
- 2022-05-09
- 2022-05-10
- 2022-05-12
- 2022-05-18
- 2022-05-25
- 2022-06-01
- 2022-06-08
- 2022-06-15
- 2022-08-03
-
2022-10-05
Dose 5 — Pfizer-BioNTechCo-administered: Flu
- 2022-10-12
- 2022-10-19
- 2022-10-26
- 2022-11-02
- 2022-11-10
- 2022-11-16
- 2023-01-04
- 2023-04-05
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-01 | Moderna | |
| 2 | 2021-01-28 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-05-04 | Moderna | No |
| 5 | 2022-10-05 | Pfizer-BioNTech | Flu |
Call center
3 call center cases
2 successful · 1 priority 2/3 (triaged and no follow up)
VAERS report filed, before or during a call: 1
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): I think that I came down with food poisoning. I ate some greens that had to have been 3 weeks in the fridge. Within 15 minutes I became nauseated, then vomiting and diarrhea.Lasted from around 11pm til 6 am when everything was finally out of my stomach. Other than feeling weak and tired, I am feeling ok now. My symptoms when I had them were severe. Now I am good. The food was spoiled.
Release 10 — day 42, dose 3
Symptoms: Blood clot in lower leg
Release 11 — 3 months, dose 3
Symptoms: Entrapment of popliteal artery
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 | Arterial disorder | · | · | ✓ |
| SD | Thrombosis | · | · | ✓ |
| SRO | Asthenia | ✓ | ✓ | ✓ |
| SRO | Diarrhoea | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Food poisoning | ✓ | ✓ | ✓ |
| SRO | Nausea | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ○ | ○ | ○ |
| SRO | Vomiting | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release