4XZ-15255-97300
4 vaccinations
3 coded responses
35 check-ins
3 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 080 / NJ
- Registered
- 2021-02-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-05
Dose 1 — Moderna
-
2021-02-12
Registered in v-safe
-
2021-02-12
Survey response — day 7, dose 1MedDRA: Discomfort, Headache, Immediate post-injection reaction, Sinus disorder — Feeling: FairFree text: sinus issues about 45 minutes after shot. Pressure, sinus mask, head ache, 2 Benadryls helped, wasn't surprised as this happens with insect bites, mold, pollen,etc,. milder sins issues 3 nonconsecutive days.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-19
- 2021-02-26
-
2021-03-05
Dose 2 — Moderna
-
2021-03-05
Survey response — day 0, dose 2MedDRA: Self-medication, Sinus disorder, Vaccine positive rechallenge — Feeling: FairFree text: Sinus issues, same as first ejection, took two Benadryls, feeling a bit better.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-06
Survey response — days 1–6 daily, dose 2MedDRA: Back pain, Injection site pain — Feeling: Fair · Site: Pain · Muscle or body achesFree text: Sinus issues have cleared up. Sore arm at injection site, soreness in lower back. Happy with only have mild issues.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-19
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-06-04
- 2021-09-03
-
2021-10-22
Dose 3 — Moderna
- 2021-10-28
- 2021-10-29
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2022-01-21
-
2022-04-06
Dose 4 — Moderna
- 2022-04-18
- 2022-04-20
- 2022-04-27
- 2022-05-04
- 2022-05-11
- 2022-05-18
- 2022-07-06
- 2022-10-05
- 2023-04-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-05 | Moderna | |
| 2 | 2021-03-05 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-04-06 | Moderna | No |
Free text
Release 4 — day 7, dose 1
Systemic reaction (other): sinus issues about 45 minutes after shot. Pressure, sinus mask, head ache, 2 Benadryls helped, wasn't surprised as this happens with insect bites, mold, pollen,etc,. milder sins issues 3 nonconsecutive days.
Release 5 — day 0, dose 2
Systemic reaction (other): Sinus issues, same as first ejection, took two Benadryls, feeling a bit better.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Sinus issues have cleared up. Sore arm at injection site, soreness in lower back. Happy with only have mild issues.
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 |
|---|---|---|---|---|
| SRO | Back pain | ✓ | ✓ | ✓ |
| SRO | Discomfort | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Sinus disorder | ✓ | ✓ | ✓ |
| SRO | Vaccine positive rechallenge | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release