4SM-27492-04688
4 vaccinations
4 coded responses
19 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 180 / PA
- Registered
- 2021-02-20
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-19
Dose 1 — Moderna
-
2021-02-20
Registered in v-safe
- 2021-02-20
-
2021-02-21
Survey response — days 1–6 daily, dose 1MedDRA: Injection site discomfort — Feeling: GoodFree text: Only SLIGHT arm discomfort at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-22
Health check-in — days 1–6 daily, dose 1Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-02-23
- 2021-02-24
- 2021-02-25
- 2021-02-26
- 2021-03-05
- 2021-03-12
-
2021-03-19
Dose 2 — Moderna
-
2021-03-24
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness, Dry mouth, Fatigue, Gait disturbance, Hyperhidrosis, Respiratory rate increased, Vomiting — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: I had nothing other than fatigue today but 60 hrs after my second shot I had severe dizziness, sweating & vomiting for 5 hours. I was signed up with vsafe but never received a text. I was vaccinated on 3/19 and on 3/22 I had the symptoms (60 hrs later). Also rapid breathing and dry mouth (probably due to rapid breathing). Couldn't walk unassisted. Very rough.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-09-19
Survey response — 6 months, dose 2MedDRA: Bundle branch block left, Cardiac murmur, Osteoporosis — Feeling: GoodFree text: Osteoporosis, left branch bundle block (heart), soft heart murmurMedDRA releases: 2024-11 · check-in free text available
-
2021-11-05
Dose 3 — Moderna
- 2022-03-19
-
2022-04-15
Dose 4 — Moderna
- 2022-04-29
-
2022-05-06
Survey response — day 21, dose 4MedDRA: Gastrooesophageal reflux disease — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: GERD/acid refluxMedDRA releases: 2024-11 · check-in free text available
-
2022-05-06
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)
-
2022-05-09
Call successfulNot applicable - Accidental Reporting
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-07-15
- 2023-04-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-19 | Moderna | |
| 2 | 2021-03-19 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Only SLIGHT arm discomfort at injection site
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): I had nothing other than fatigue today but 60 hrs after my second shot I had severe dizziness, sweating & vomiting for 5 hours. I was signed up with vsafe but never received a text. I was vaccinated on 3/19 and on 3/22 I had the symptoms (60 hrs later). Also rapid breathing and dry mouth (probably due to rapid breathing). Couldn't walk unassisted. Very rough.
Release 9 — 6 months, dose 2
Symptoms: Osteoporosis, left branch bundle block (heart), soft heart murmur
Release 11 — day 21, dose 4
Symptoms: GERD/acid reflux
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 | Bundle branch block left | · | · | ✓ |
| SD | Cardiac murmur | · | · | ✓ |
| SD | Gastrooesophageal reflux disease | · | · | ✓ |
| SD | Osteoporosis | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Dry mouth | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Gait disturbance | ✓ | ✓ | ✓ |
| SRO | Hyperhidrosis | ✓ | ✓ | ✓ |
| SRO | Injection site discomfort | ✓ | ✓ | ✓ |
| SRO | Respiratory rate increased | ✓ | ✓ | ✓ |
| SRO | Vomiting | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release