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4XB-10057-95296

2 vaccinations 8 coded responses 17 check-ins 8 free-text entries 0 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
546 / WI
Registered
2021-02-10
Relationship
Self
Race
White
Ethnicity
N/A

Timeline

  1. 2021-02-08
    Dose 1 — Moderna
  2. 2021-02-10
    Registered in v-safe
  3. 2021-02-10
    Survey response — days 1–6 daily, dose 1
    MedDRA: Fatigue, Ophthalmic migraine, Sleep disorder — Feeling: Good · Site: Pain, Swelling
    Free text: Yesterday, 2/9, I had ocular migraine, fatigue after and slept heavily for 2 hrs.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-11
    Survey response — days 1–6 daily, dose 1
    MedDRA: Stress — Feeling: Good · Fatigue or tiredness
    Free text: A little more easily stressed
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-02-12
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-02-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-02-15
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-02-24
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  9. 2021-03-03
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-03-11
    Dose 2 — Moderna
  11. 2021-03-11
    Health check-in — day 0, dose 2
    Feeling: Fair · Headache
    Adult check-in
  12. 2021-03-12
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Swelling · None
    Adult check-in
  13. 2021-03-13
    Survey response — days 1–6 daily, dose 2
    MedDRA: Adverse reaction — Feeling: Good · Site: Pain, Swelling · Muscle or body aches
    Free text: Just in the deltoid, slightly more than day 2.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-03-14
    Survey response — days 1–6 daily, dose 2
    MedDRA: Oral herpes — Feeling: Good · Rash, not including the immediate area around the injection site
    Free text: Broke out in 1st cold sore I have ever had!!
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-03-15
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-03-16
    Survey response — days 1–6 daily, dose 2
    MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Site: Itching · Joint pains
    Free text: Exacerbated knee pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-03-17
    Survey response — days 1–6 daily, dose 2
    MedDRA: Diarrhoea, Injection site warmth — Feeling: Good · Site: Itching · Diarrhea
    Free text: Loose bm, arm site is feverish, 2 to 3 degrees warmer than non shot site.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-03-18
    Survey response — day 7, dose 2
    MedDRA: Diverticulitis — Feeling: Poor · Site: Itching · Diarrhea, Abdominal pain · Be unable to do your normal daily activities
    Free text: Something has aggravated my diverticulitis.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-03-27
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-04-01
    Survey response — day 21, dose 2
    MedDRA: Crying, Distractibility, Impaired work ability, Pyrexia — Feeling: Fair
    Free text: Low grade fever, 99 degrees, distracted at work, weepy, went home from work.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-02-08Moderna
22021-03-11Moderna

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-10

Systemic reaction (other): Yesterday, 2/9, I had ocular migraine, fatigue after and slept heavily for 2 hrs.

2021-02-11

Systemic reaction (other): A little more easily stressed

Release 5 — days 1–6 daily, dose 2

2021-03-13

Systemic reaction (other): Just in the deltoid, slightly more than day 2.

2021-03-14

Systemic reaction (other): Broke out in 1st cold sore I have ever had!!

2021-03-16

Systemic reaction (other): Exacerbated knee pain

2021-03-17

Systemic reaction (other): Loose bm, arm site is feverish, 2 to 3 degrees warmer than non shot site.

Release 5 — day 7, dose 2

2021-03-18

Systemic reaction (other): Something has aggravated my diverticulitis.

Release 6 — day 21, dose 2

2021-04-01

Symptoms: Low grade fever, 99 degrees, distracted at work, weepy, went home from work.

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

FieldPreferred term2021-092023-042024-11
SDCrying ✓ ✓ ✓
SDDistractibility ✓ ✓ ✓
SDImpaired work ability ✓ ✓ ✓
SDPyrexia ✓ ✓ ✓
SROAdverse reaction ✓ ✓ ✓
SROCondition aggravated ✓ ✓ ✓
SRODiarrhoea ✓ ✓ ✓
SRODiverticulitis ✓ ✓ ✓
SROFatigue ✓ ✓ ✓
SROInjection site warmth ✓ ✓ ✓
SROOphthalmic migraine ✓ ✓ ✓
SROOral herpes ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓
SROSleep disorder ✓ ✓ ✓
SROStress ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release