4SX-25070-79053
2 vaccinations
5 coded responses
20 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 124 / NY
- Registered
- 2021-03-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-01
Dose 1 — Moderna
-
2021-03-02
Registered in v-safe
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2021-03-02
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-03-03
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Joint pains, Muscle or body achesAdult check-in
-
2021-03-04
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-03-05
Health check-in — days 1–6 daily, dose 1Feeling: Good · Chills, Fatigue or tirednessAdult check-in
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-15
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2021-03-22
Survey response — day 21, dose 1MedDRA: Back pain, Muscle spasms, Muscular weakness, Sleep disorder — 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: Last Tuesday I woke up to (10+ on the pain scale) painful lower lumbar back spasms on my right side. My right leg dropped out from under me a few times. I needed a cane & prayer to get out of bed in the morning.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-22
Report sent to call center — day 21, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-03-29
Dose 2 — Moderna
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2021-03-29
Health check-in — day 0, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Fatigue or tirednessAdult check-in
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2021-03-30
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-03-31
Survey response — days 1–6 daily, dose 2MedDRA: Injection site erythema, Injection site warmth — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: The area that's red & round at the injection site feels hot, both yesterday afternoon & more so todayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-01
Survey response — days 1–6 daily, dose 2MedDRA: Rash — Feeling: Fair · Site: Pain, Redness · Chills, Headache, Joint painsFree text: I have a rash on my forehead & cheeks on my face. Doesn't hurt or itchMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-02
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2021-04-03
Survey response — days 1–6 daily, dose 2MedDRA: Rash — Feeling: Good · Chills, Rash, not including the immediate area around the injection siteFree text: Rash on my forehead & facial cheeksMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-04
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2021-04-05
Survey response — day 7, dose 2MedDRA: Dizziness — Feeling: Fair · Chills, NauseaFree text: Dizziness. Almost fell down.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-12
- 2021-04-19
- 2021-06-28
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2021-12-13
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-01 | Moderna | |
| 2 | 2021-03-29 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 6 — day 21, dose 1
Symptoms: Last Tuesday I woke up to (10+ on the pain scale) painful lower lumbar back spasms on my right side. My right leg dropped out from under me a few times. I needed a cane & prayer to get out of bed in the morning.
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): The area that's red & round at the injection site feels hot, both yesterday afternoon & more so today
Systemic reaction (other): I have a rash on my forehead & cheeks on my face. Doesn't hurt or itch
Systemic reaction (other): Rash on my forehead & facial cheeks
Release 6 — day 7, dose 2
Systemic reaction (other): Dizziness. Almost fell down.
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 | Back pain | ✓ | ✓ | ✓ |
| SD | Muscle spasms | ✓ | ✓ | ✓ |
| SD | Muscular weakness | ✓ | ✓ | ✓ |
| SD | Sleep disorder | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | ✓ | ✓ | ✓ |
| SRO | Injection site warmth | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release