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
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2021-02-08
Dose 1 — Moderna
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2021-02-10
Registered in v-safe
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2021-02-10
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue, Ophthalmic migraine, Sleep disorder — Feeling: Good · Site: Pain, SwellingFree 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
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2021-02-11
Survey response — days 1–6 daily, dose 1MedDRA: Stress — Feeling: Good · Fatigue or tirednessFree text: A little more easily stressedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-12
- 2021-02-14
- 2021-02-15
- 2021-02-24
- 2021-03-03
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2021-03-11
Dose 2 — Moderna
- 2021-03-11
- 2021-03-12
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2021-03-13
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Good · Site: Pain, Swelling · Muscle or body achesFree text: Just in the deltoid, slightly more than day 2.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-14
Survey response — days 1–6 daily, dose 2MedDRA: Oral herpes — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Broke out in 1st cold sore I have ever had!!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-15
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2021-03-16
Survey response — days 1–6 daily, dose 2MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Site: Itching · Joint painsFree text: Exacerbated knee painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-17
Survey response — days 1–6 daily, dose 2MedDRA: Diarrhoea, Injection site warmth — Feeling: Good · Site: Itching · DiarrheaFree 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
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2021-03-18
Survey response — day 7, dose 2MedDRA: Diverticulitis — Feeling: Poor · Site: Itching · Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: Something has aggravated my diverticulitis.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-27
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2021-04-01
Survey response — day 21, dose 2MedDRA: Crying, Distractibility, Impaired work ability, Pyrexia — Feeling: FairFree 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
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-08 | Moderna | |
| 2 | 2021-03-11 | Moderna |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Yesterday, 2/9, I had ocular migraine, fatigue after and slept heavily for 2 hrs.
Systemic reaction (other): A little more easily stressed
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Just in the deltoid, slightly more than day 2.
Systemic reaction (other): Broke out in 1st cold sore I have ever had!!
Systemic reaction (other): Exacerbated knee pain
Systemic reaction (other): Loose bm, arm site is feverish, 2 to 3 degrees warmer than non shot site.
Release 5 — day 7, dose 2
Systemic reaction (other): Something has aggravated my diverticulitis.
Release 6 — day 21, dose 2
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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| SD | Crying | ✓ | ✓ | ✓ |
| SD | Distractibility | ✓ | ✓ | ✓ |
| SD | Impaired work ability | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Condition aggravated | ✓ | ✓ | ✓ |
| SRO | Diarrhoea | ✓ | ✓ | ✓ |
| SRO | Diverticulitis | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Injection site warmth | ✓ | ✓ | ✓ |
| SRO | Ophthalmic migraine | ✓ | ✓ | ✓ |
| SRO | Oral herpes | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Sleep disorder | ✓ | ✓ | ✓ |
| SRO | Stress | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release