4YX-20019-84373
2 vaccinations
6 coded responses
15 check-ins
6 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 606 / IL
- Registered
- 2021-03-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-11
Dose 1 — Moderna
-
2021-03-04
Registered in v-safe
-
2021-03-04
Survey response — day 21, dose 1MedDRA: Diarrhoea, Fatigue, Injection site erythema, Injection site pruritus, Injection site rash, Pruritus — Feeling: GoodFree text: Rash at injection site about 5-7 days after vaccine, 3 in diameter, red, slightly itchy. Also, fatigue and diarrhea.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-11
Dose 2 — Moderna
- 2021-03-11
-
2021-03-12
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Redness · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-13
-
2021-03-14
Survey response — days 1–6 daily, dose 2MedDRA: Lung disorder, Productive cough — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: My lungs don't feel well, coughing up some mucus.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-15
Survey response — days 1–6 daily, dose 2MedDRA: Pulmonary pain — Feeling: Fair · Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: My lungs hurtMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-16
- 2021-03-17
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2021-03-18
Survey response — day 7, dose 2MedDRA: COVID-19, Pre-existing disease, SARS-CoV-2 antibody test positive — Feeling: GoodFree text: I did want to add that I have the MTHFR gene mutation, and had I what I believe to be Covid-19 a year ago, before testing was available. I did test positive for antibodies.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-25
- 2021-04-01
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2021-04-08
Survey response — day 28, dose 2MedDRA: Chills, Fatigue, Headache, Lymphadenopathy, Myalgia, Oropharyngeal pain — Feeling: FairFree text: Fatigue, sore throat, chills, headache, muscle soreness, also swollen lymph nodes.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-15
- 2021-04-22
-
2021-09-09
Survey response — 6 months, dose 2MedDRA: Diarrhoea — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: DiarrheaMedDRA releases: 2024-11 · check-in free text available
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2021-09-09
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-09-15
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-11 | Moderna | |
| 2 | 2021-03-11 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 5 — day 21, dose 1
Symptoms: Rash at injection site about 5-7 days after vaccine, 3 in diameter, red, slightly itchy. Also, fatigue and diarrhea.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): My lungs don't feel well, coughing up some mucus.
Systemic reaction (other): My lungs hurt
Release 5 — day 7, dose 2
Systemic reaction (other): I did want to add that I have the MTHFR gene mutation, and had I what I believe to be Covid-19 a year ago, before testing was available. I did test positive for antibodies.
Release 7 — day 28, dose 2
Symptoms: Fatigue, sore throat, chills, headache, muscle soreness, also swollen lymph nodes.
Release 9 — 6 months, dose 2
Symptoms: 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 | Chills | ✓ | ✓ | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Injection site erythema | · | · | ✓ |
| SD | Injection site pruritus | · | · | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SD | Lymphadenopathy | ✓ | ✓ | ✓ |
| SD | Myalgia | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Pruritus | ✓ | ✓ | ○ |
| SRO | COVID-19 | ✓ | ✓ | ✓ |
| SRO | Lung disorder | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Productive cough | ✓ | ✓ | ✓ |
| SRO | Pulmonary pain | ✓ | ✓ | ✓ |
| SRO | SARS-CoV-2 antibody test positive | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release