4VW-53499-34621
5 vaccinations
13 coded responses
68 check-ins
12 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 981 / WA
- Registered
- 2021-01-27
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-27
Registered in v-safe
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2021-01-27
Dose 1 — Moderna
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2021-01-27
Survey response — day 0, dose 1MedDRA: Lip swelling, Nasal congestion — Feeling: Fair · Headache, Muscle or body achesFree text: Lips and nasal area feel slightly swollenMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-28
Health check-in — days 1–6 daily, dose 1Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visitAdult check-in
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2021-01-28
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
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2021-02-02
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-02-03
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2021-02-10
Survey response — day 14, dose 1MedDRA: Eye irritation, Headache, Insomnia, Pain — Feeling: FairFree text: Headache, body ache, dry, irritated eyes, difficulty sleepingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-17
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2021-02-24
Survey response — day 28, dose 1MedDRA: Gastrooesophageal reflux disease — Feeling: GoodFree text: Increase in occurrences of acid reflux at night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-03
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2021-03-10
Dose 2 — Moderna
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2021-03-10
Survey response — day 0, dose 2MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessFree text: Dizzy, light headedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-11
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Fair · Site: Pain, Swelling · Fever · Joint pains, Fatigue or tirednessFree text: Some dizzynessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-12
Survey response — days 1–6 daily, dose 2MedDRA: Renal pain — Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tirednessFree text: Sporadic left side kidney painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-18
- 2021-03-24
- 2021-03-31
- 2021-04-09
- 2021-04-14
- 2021-04-21
-
2021-06-08
Call successfulCompleted over the phone
- 2021-06-09
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2021-09-08
Survey response — 6 months, dose 2MedDRA: Headache, Nausea, Neck pain — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Neck pain, headache, nauseaMedDRA releases: 2024-11 · check-in free text available
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2021-09-08
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-09-14
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
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2021-11-05
Dose 3 — Moderna
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2021-11-05
Health check-in — day 0, dose 3Feeling: Fair · Fever · Headache, Fatigue or tirednessAdult check-in
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2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-11-07
- 2021-11-08
- 2021-11-09
- 2021-11-11
- 2021-11-12
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2021-11-19
Survey response — day 14, dose 3MedDRA: Headache, Nausea, Oropharyngeal pain — Feeling: PoorFree text: Intermittent symptoms. Headache, nausea, sore throat. Comes and goes.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2021-12-17
- 2022-02-04
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2022-03-31
Dose 4 — Moderna
- 2022-03-31
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2022-04-01
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal painAdult check-in
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2022-04-02
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Itching · Headache, Fatigue or tirednessAdult check-in
- 2022-04-03
- 2022-04-05
- 2022-04-06
- 2022-04-07
- 2022-04-14
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2022-04-21
Survey response — day 21, dose 4MedDRA: Eye pruritus, Hypersensitivity, Pre-existing disease, Sinus headache, Toothache — Feeling: FairFree text: Very compelling pollen allergy. Painful sinus headache, upper teeth pain and itchy eyes.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-28
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2022-05-05
Survey response — day 35, dose 4MedDRA: Headache, Histamine abnormal, Paranasal sinus inflammation, Pre-existing disease, Urticaria — Feeling: FairFree text: Severe pollen allergies. Headache, sinus inflammation, histimine responsesMedDRA releases: 2024-11 · check-in free text available
- 2022-05-12
- 2022-06-30
- 2022-09-29
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2022-10-26
Dose 5 — Moderna
- 2022-10-26
- 2022-10-27
- 2022-10-28
- 2022-10-29
- 2022-10-30
- 2022-10-31
- 2022-11-01
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2022-11-02
Survey response — day 7, dose 5MedDRA: Insomnia — Feeling: Fair · Headache, Joint pains, Fatigue or tiredness, Abdominal painFree text: InsomniaMedDRA releases: 2024-11 · check-in free text available
- 2022-11-10
- 2022-11-16
- 2022-11-24
- 2022-11-30
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2022-12-07
Survey response — day 42, dose 5MedDRA: Diarrhoea, Headache, Muscle spasms — Feeling: FairFree text: Headache, cramping, diarrheaMedDRA releases: 2024-11 · check-in free text available
- 2023-01-27
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2023-04-26
Survey response — 6 months, dose 5MedDRA: Gastrointestinal viral infection, Respiratory tract infection viral — Feeling: Good · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-27 | Moderna | |
| 2 | 2021-03-10 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-03-31 | Moderna | No |
| 5 | 2022-10-26 | Moderna | No |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 1
Free text
Release 2 — day 0, dose 1
Systemic reaction (other): Lips and nasal area feel slightly swollen
Release 3 — day 14, dose 1
Symptoms: Headache, body ache, dry, irritated eyes, difficulty sleeping
Release 4 — day 28, dose 1
Symptoms: Increase in occurrences of acid reflux at night.
Release 5 — day 0, dose 2
Systemic reaction (other): Dizzy, light headed
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Some dizzyness
Systemic reaction (other): Sporadic left side kidney pain
Release 9 — 6 months, dose 2
Symptoms: Neck pain, headache, nausea
Release 10 — day 14, dose 3
Symptoms: Intermittent symptoms. Headache, nausea, sore throat. Comes and goes.
Release 11 — day 21, dose 4
Symptoms: Very compelling pollen allergy. Painful sinus headache, upper teeth pain and itchy eyes.
Release 11 — day 35, dose 4
Symptoms: Severe pollen allergies. Headache, sinus inflammation, histimine responses
Release 12 — day 7, dose 5
Systemic reaction (other): Insomnia
Release 12 — day 42, dose 5
Symptoms: Headache, cramping, diarrhea
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 | Diarrhoea | · | · | ✓ |
| SD | Eye irritation | ✓ | ✓ | ✓ |
| SD | Eye pruritus | · | · | ✓ |
| SD | Gastrointestinal viral infection | · | · | ✓ |
| SD | Gastrooesophageal reflux disease | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Histamine abnormal | · | · | ✓ |
| SD | Hypersensitivity | · | · | ✓ |
| SD | Insomnia | ✓ | ✓ | ✓ |
| SD | Muscle spasms | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Neck pain | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Paranasal sinus inflammation | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Respiratory tract infection viral | · | · | ✓ |
| SD | Sinus headache | · | · | ✓ |
| SD | Toothache | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Insomnia | · | · | ✓ |
| SRO | Lip swelling | ✓ | ✓ | ✓ |
| SRO | Nasal congestion | ✓ | ✓ | ✓ |
| SRO | Renal pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release