54Y-25697-17674
2 vaccinations
4 coded responses
24 check-ins
4 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 720 / AR
- Registered
- 2021-04-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-30
Registered in v-safe
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2021-04-30
Dose 1 — Moderna
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2021-04-30
Health check-in — day 0, dose 1Feeling: Fair · Site: Pain · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-05-01
- 2021-05-02
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2021-05-03
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: GoodFree text: Bottom left corner mouth appeared Saturday when i woke up. Size of m m candy. Looks horrible bleeds and crack open and itchy. Putting triple antibiotic ointment on it. What is this ??MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-04
Survey response — days 1–6 daily, dose 1MedDRA: Mouth haemorrhage, Oral pruritus — Feeling: GoodFree text: Spot on my left bottom side of mouth itchy and bled this morningMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-05
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2021-05-06
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-05-07
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2021-05-14
Survey response — day 14, dose 1MedDRA: Hypersensitivity, Lip blister, Mouth ulceration, Office visit, Vision blurred, Visual impairment — Feeling: FairFree text: Mouth uclers and blisters on bottom lip.Left eye white area chamois has wrinkle and saw blue dots. My vision us blurry. Went Dr. Said this was a allergic reaction to something.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-23
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2021-05-28
Dose 2 — Moderna
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2021-05-28
Health check-in — day 0, dose 2Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tirednessAdult check-in
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2021-05-29
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling · Headache, Fatigue or tirednessAdult check-in
- 2021-05-30
- 2021-06-01
- 2021-06-02
- 2021-06-03
- 2021-06-04
- 2021-06-11
- 2021-06-18
- 2021-06-25
- 2021-07-04
- 2021-07-09
- 2021-08-29
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2021-11-26
Survey response — 6 months, dose 2MedDRA: Bronchitis, Unevaluable event — Feeling: GoodFree text: Bronchitis Sinus TitusMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-30 | Moderna | |
| 2 | 2021-05-28 | Moderna |
Free text
Release 8 — days 1–6 daily, dose 1
Systemic reaction (other): Bottom left corner mouth appeared Saturday when i woke up. Size of m m candy. Looks horrible bleeds and crack open and itchy. Putting triple antibiotic ointment on it. What is this ??
Systemic reaction (other): Spot on my left bottom side of mouth itchy and bled this morning
Release 8 — day 14, dose 1
Symptoms: Mouth uclers and blisters on bottom lip.Left eye white area chamois has wrinkle and saw blue dots. My vision us blurry. Went Dr. Said this was a allergic reaction to something.
Release 10 — 6 months, dose 2
Symptoms: Bronchitis Sinus Titus
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 | Bronchitis | · | · | ✓ |
| SD | Hypersensitivity | ✓ | ✓ | ✓ |
| SD | Lip blister | ✓ | ✓ | ✓ |
| SD | Mouth ulceration | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SD | Vision blurred | ✓ | ✓ | ✓ |
| SD | Visual impairment | ✓ | ✓ | ✓ |
| SRO | Mouth haemorrhage | ✓ | ✓ | ✓ |
| SRO | Oral pruritus | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release