4SJ-30329-20907
2 vaccinations
2 coded responses
18 check-ins
2 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 750 / TX
- Registered
- 2021-01-23
- Relationship
- Self
- Race
- American Indian or Alaska Native
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-22
Dose 1 — Moderna
-
2021-01-23
Registered in v-safe
-
2021-01-23
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tirednessAdult check-in
-
2021-01-24
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection siteAdult check-in
-
2021-01-25
Survey response — days 1–6 daily, dose 1MedDRA: Drug hypersensitivity, Pre-existing disease, Rash, Systemic lupus erythematosus — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Joint pains, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to workFree text: I have lupus & an allergy to PCN. The rash is all over my chest, neck and part of my backMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-26
- 2021-01-27
- 2021-01-28
-
2021-01-29
Health check-in — day 7, dose 1Feeling: Good · Site: Redness, Swelling, Itching · NoneAdult check-in
- 2021-02-05
- 2021-02-12
- 2021-02-19
-
2021-02-21
Dose 2 — Moderna
-
2021-02-25
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-07
- 2021-03-14
- 2021-04-04
-
2022-02-23
Survey response — 12 months, dose 2MedDRA: COVID-19 — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: I had Covid 2x in JanuaryMedDRA releases: 2024-11 · check-in free text available
-
2022-02-23
Report sent to call center — 12 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2022-03-03
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-02-21 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-23 | Unsuccessful |
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): I have lupus & an allergy to PCN. The rash is all over my chest, neck and part of my back
Release 11 — 12 months, dose 2
Symptoms: I had Covid 2x in January
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 | COVID-19 | · | · | ✓ |
| SRO | Drug hypersensitivity | ○ | ✓ | ○ |
| SRO | Pre-existing disease | ✓ | · | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Systemic lupus erythematosus | ○ | ✓ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release