4V5-31385-33566
3 vaccinations
9 coded responses
34 check-ins
9 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 230 / VA
- Registered
- 2021-01-23
- Relationship
- Self
- Race
- American Indian or Alaska Native
- Ethnicity
- Not Hispanic or Latino
Registered dependents
ASR-15057-34954
Child or adolescent in my care · Male · 2021-07-06
Timeline
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2021-01-23
Registered in v-safe
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2021-01-23
Dose 1 — Moderna
- 2021-01-23
- 2021-01-24
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2021-01-25
Survey response — days 1–6 daily, dose 1MedDRA: Adverse reaction — Feeling: PoorFree text: Breathing, chest but probably related to other issuesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-26
Survey response — days 1–6 daily, dose 1MedDRA: Cardiac disorder, Dyspnoea — Feeling: Poor · Fatigue or tiredness · Be unable to workFree text: Breathing issues and heart issuesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-27
- 2021-01-28
- 2021-01-29
- 2021-01-30
- 2021-02-06
- 2021-02-13
- 2021-02-20
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2021-02-27
Dose 2 — Moderna
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2021-02-27
Survey response — day 0, dose 2MedDRA: Erythema — Feeling: GoodFree text: Face got red for about an hour.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Joint pains, Nausea · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
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2021-03-13
Survey response — day 14, dose 2MedDRA: Headache, Lymphadenopathy — Feeling: FairFree text: Swollen glands and lymph nodes. HeadachesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-20
- 2021-03-27
- 2021-04-03
- 2021-04-10
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2021-05-29
Survey response — 3 months, dose 2MedDRA: Aneurysm, Condition aggravated, Nodule, Pre-existing disease, Thrombosis — Feeling: Poor · Be unable to workFree text: Heart problems getting worse, aneurysm with blood clot, nodules. I think most were before getting a vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-08-30
Survey response — 6 months, dose 2MedDRA: Chest discomfort, Nasal congestion — Feeling: FairFree text: Chest feels alittle tight, nose has been a tiny bit stuffy.MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-09-02
Dose 3 — Moderna
- 2021-09-09
- 2021-09-16
- 2021-09-23
- 2021-09-30
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2021-10-09
Survey response — day 35, dose 3MedDRA: Cough, Malaise, Respiratory tract congestion, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Chest congestion, cough, sinuses, sick. I caught this from my sons who both tested negative for Covid.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-14
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2021-12-02
Survey response — 3 months, dose 3MedDRA: Cough, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, Sinus headache, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Sinus headache, pressure, runny and stuffy nose, coughing, throat hurtsMedDRA releases: 2024-11 · check-in free text available
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2022-03-03
Survey response — 6 months, dose 3MedDRA: Bacterial infection, Sinusitis — Feeling: Good · Be unable to do your normal daily activitiesFree text: Bacterial sinus infectionMedDRA releases: 2024-11 · check-in free text available
- 2022-09-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-23 | Moderna | |
| 2 | 2021-02-27 | Moderna | |
| 3 | 2021-09-02 | Moderna | No |
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Breathing, chest but probably related to other issues
Systemic reaction (other): Breathing issues and heart issues
Release 4 — day 0, dose 2
Systemic reaction (other): Face got red for about an hour.
Release 5 — day 14, dose 2
Symptoms: Swollen glands and lymph nodes. Headaches
Release 8 — 3 months, dose 2
Symptoms: Heart problems getting worse, aneurysm with blood clot, nodules. I think most were before getting a vaccine.
Release 9 — 6 months, dose 2
Symptoms: Chest feels alittle tight, nose has been a tiny bit stuffy.
Release 10 — day 35, dose 3
Symptoms: Chest congestion, cough, sinuses, sick. I caught this from my sons who both tested negative for Covid.
Release 10 — 3 months, dose 3
Symptoms: Sinus headache, pressure, runny and stuffy nose, coughing, throat hurts
Release 11 — 6 months, dose 3
Symptoms: Bacterial sinus infection
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 | Aneurysm | ✓ | ✓ | ✓ |
| SD | Bacterial infection | · | · | ✓ |
| SD | Chest discomfort | ✓ | · | ✓ |
| SD | Condition aggravated | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Lymphadenopathy | ✓ | ✓ | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Nasal congestion | ✓ | · | ✓ |
| SD | Nodule | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Sinus headache | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SD | Thrombosis | ✓ | ✓ | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Cardiac disorder | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | ✓ | ✓ | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release