555-22981-41899
4 vaccinations
5 coded responses
28 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 783 / TX
- Registered
- 2021-11-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Registered dependents
KHC-32180-97395
Adult relative or friend · Male · 2021-11-18
Timeline
-
2021-03-18
Dose 1 — Moderna
-
2021-04-21
Dose 2 — Moderna
-
2021-11-18
Registered in v-safe
-
2021-11-18
Dose 3 — Moderna
- 2021-11-18
- 2021-11-19
- 2021-11-20
- 2021-11-21
- 2021-11-22
- 2021-11-23
- 2021-11-25
-
2021-12-02
Survey response — day 14, dose 3MedDRA: Headache — Feeling: GoodFree text: Slight headache on two different days.MedDRA releases: 2024-11 · check-in free text available
- 2021-12-09
- 2021-12-16
- 2021-12-23
- 2021-12-31
- 2022-02-18
- 2022-05-19
-
2022-06-01
Dose 4 — Moderna
-
2022-06-01
Health check-in — day 0, dose 4Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
-
2022-06-02
Survey response — days 1–6 daily, dose 4MedDRA: Injection site nodule — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tirednessFree text: Feel like I have a knot at the injection site, if this is swelling then it is mild.MedDRA releases: 2024-11 · check-in free text available
-
2022-06-03
Survey response — days 1–6 daily, dose 4MedDRA: Headache, Pain in jaw — Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tirednessFree text: Slight pain in upper jaw as if I have been grinding my teeth but have not been grinding teeth since day 2 and 3 along with headache.MedDRA releases: 2024-11 · check-in free text available
-
2022-06-05
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Itching · Fatigue or tirednessAdult check-in
- 2022-06-07
- 2022-06-08
- 2022-06-15
- 2022-06-22
- 2022-06-29
- 2022-07-06
-
2022-07-13
Survey response — day 42, dose 4MedDRA: Heat exhaustion, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Heat exhaustion symptoms due to unusually high temperatures it' has taken about a week to fully recover. Currently under a doctor's care. · Healthcare visit (other): Health visit to primary doctorMedDRA releases: 2024-11 · check-in free text available
-
2022-07-13
Report sent to call center — day 42, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2022-07-14
- 2022-08-31
- 2022-11-30
-
2023-06-03
Survey response — 12 months, dose 4MedDRA: Asthenia, Office visit, Trigger finger — Feeling: Good · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
-
2023-06-03
Call case (no matching report) — SuccessfulDoes not wish to fill out VAERS report
- 2023-06-05
- 2023-06-05
- 2023-06-08
- 2023-06-08
-
2023-06-08
Call successfulDoes not wish to fill out VAERS report
-
2023-06-08
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-18 | Moderna | No |
| 2 | 2021-04-21 | Moderna | No |
| 3 | 2021-11-18 | Moderna | No |
| 4 | 2022-06-01 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 10 — day 14, dose 3
Symptoms: Slight headache on two different days.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Feel like I have a knot at the injection site, if this is swelling then it is mild.
Systemic reaction (other): Slight pain in upper jaw as if I have been grinding my teeth but have not been grinding teeth since day 2 and 3 along with headache.
Release 12 — day 42, dose 4
Symptoms: Heat exhaustion symptoms due to unusually high temperatures it' has taken about a week to fully recover. Currently under a doctor's care.
Healthcare visit (other): Health visit to primary doctor
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 | Asthenia | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Heat exhaustion | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Trigger finger | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Injection site nodule | · | · | ✓ |
| SRO | Pain in jaw | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release