53R-11565-41406
5 vaccinations
14 coded responses
61 check-ins
12 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 983 / WA
- Registered
- 2021-03-12
- Relationship
- Self
- Race
- Multiracial
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-12
Registered in v-safe
-
2021-03-12
Dose 1 — Moderna
- 2021-03-12
-
2021-03-13
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
-
2021-03-18
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-19
- 2021-03-26
- 2021-04-02
-
2021-04-09
Dose 2 — Moderna
-
2021-04-09
Survey response — day 0, dose 2MedDRA: No adverse event — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: No, not at this time. Its only been a few hours.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-10
Survey response — days 1–6 daily, dose 2MedDRA: No adverse event — Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Itching · Fatigue or tirednessAdult check-in
- 2021-04-12
- 2021-04-13
- 2021-04-14
- 2021-04-15
- 2021-04-16
- 2021-04-23
- 2021-04-30
- 2021-05-07
- 2021-05-14
- 2021-05-21
- 2021-07-09
- 2021-10-08
-
2021-10-29
Dose 3 — Moderna
- 2021-10-29
- 2021-10-30
-
2021-10-31
Survey response — days 1–6 daily, dose 3MedDRA: Malaise, Self-medication — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: Last night I was sick but took Tylenol and feel better todayMedDRA releases: 2024-11 · check-in free text available
-
2021-11-01
Survey response — days 1–6 daily, dose 3MedDRA: Adverse reaction — Feeling: Good · Site: Itching · Fatigue or tirednessFree text: Feeling much better todayMedDRA releases: 2024-11 · check-in free text available
-
2021-11-02
Survey response — days 1–6 daily, dose 3MedDRA: Pain in extremity — Feeling: Good · Site: ItchingFree text: Arm is still sore but very mild sorenessMedDRA releases: 2024-11 · check-in free text available
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2022-01-28
-
2022-04-10
Dose 4 — Moderna
-
2022-04-15
Survey response — days 1–6 daily, dose 4MedDRA: Chills, Influenza like illness, Malaise, Pain — Feeling: FairFree text: I got my shot on April 10th and I had a lot more symptons this time than all other previous shots. Monday, April 11th starting at 10:30 got sick with chills, body aches, it felt like the flu. Went to bed at 3:00 and stayed I. Bed for 12 hrs.MedDRA releases: 2024-11 · check-in free text available
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2022-04-17
Survey response — day 7, dose 4MedDRA: Headache, Pre-existing disease — Feeling: Good · HeadacheFree text: Headache I think is from sinuses and allergies.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-24
- 2022-05-01
- 2022-05-08
- 2022-05-15
- 2022-05-22
-
2022-07-10
Survey response — 3 months, dose 4MedDRA: COVID-19 — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: I have CovidMedDRA releases: 2024-11 · check-in free text available
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2022-10-08
Dose 5 — ModernaCo-administered: Flu
-
2022-10-09
Survey response — 6 months, dose 4MedDRA: COVID-19, Diverticulitis, Emergency care, Lipoma, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: I got Covid on July 7th along with diverticulitis and a giant lopima all at the same time and had to go to the emergency but my Covid was negative with my at home test when I went to the emergency on around July 13th or 14th.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-09
Report sent to call center — 6 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · 1 call case(s)
-
2022-10-10
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain, Redness · Fatigue or tirednessAdult check-in
-
2022-10-10
Call successfulNot applicable - Accidental Reporting
- 2022-10-11
-
2022-10-12
Survey response — days 1–6 daily, dose 5MedDRA: Adverse reaction — Feeling: GoodFree text: I'm doing much better and feel normal now.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-13
Survey response — days 1–6 daily, dose 5MedDRA: Constipation — Feeling: GoodFree text: ConstipationMedDRA releases: 2024-11 · check-in free text available
- 2022-10-14
- 2022-10-15
- 2022-10-22
- 2022-10-29
- 2022-11-05
- 2022-11-12
- 2022-11-19
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2023-01-07
Survey response — 3 months, dose 5MedDRA: Breast cancer, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
-
2023-01-07
Report sent to call center — 3 months, dose 5Get care from a doctor or other healthcare professional1 call case(s)
- 2023-01-10
-
2023-04-08
Survey response — 6 months, dose 5MedDRA: Breast cancer — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-04-08
Report sent to call center — 6 months, dose 5Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-04-10
- 2023-04-10
-
2023-04-11
Call successfulDoes not wish to fill out VAERS report
-
2023-04-11
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-12 | Moderna | |
| 2 | 2021-04-09 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-04-10 | Moderna | No |
| 5 | 2022-10-08 | Moderna | Flu |
Call center
3 call center cases
3 successful
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): None
Release 7 — day 0, dose 2
Systemic reaction (other): No, not at this time. Its only been a few hours.
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): No
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Last night I was sick but took Tylenol and feel better today
Systemic reaction (other): Feeling much better today
Systemic reaction (other): Arm is still sore but very mild soreness
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): I got my shot on April 10th and I had a lot more symptons this time than all other previous shots. Monday, April 11th starting at 10:30 got sick with chills, body aches, it felt like the flu. Went to bed at 3:00 and stayed I. Bed for 12 hrs.
Release 11 — day 7, dose 4
Systemic reaction (other): Headache I think is from sinuses and allergies.
Release 12 — 3 months, dose 4
Symptoms: I have Covid
Release 12 — 6 months, dose 4
Symptoms: I got Covid on July 7th along with diverticulitis and a giant lopima all at the same time and had to go to the emergency but my Covid was negative with my at home test when I went to the emergency on around July 13th or 14th.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): I'm doing much better and feel normal now.
Systemic reaction (other): Constipation
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 |
|---|---|---|---|---|
| HCVO | Office visit | · | · | ✓ |
| SD | Breast cancer | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Diverticulitis | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Lipoma | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Adverse reaction | · | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Constipation | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Influenza like illness | · | · | ✓ |
| SRO | Malaise | · | · | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Self-medication | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release