556-29803-61208
1 vaccination
2 coded responses
5 check-ins
2 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 615 / IL
- Registered
- 2021-04-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-23
Dose 1 — Moderna
-
2021-04-18
Registered in v-safe
- 2021-04-18
- 2021-04-20
- 2021-06-22
-
2021-09-21
Survey response — 6 months, dose 1MedDRA: Gait disturbance, Neuropathy peripheral, Office visit, Pain in extremity, Pre-existing disease, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Nerothopy which causes my right leg to drag and the pain is so bad ialso suffer from a botched left hip replacement both knees bone on bone for 3 or 4 years and Vericose veins. Waist down i suffer tremendously and need someone to help me with chronic · Healthcare visit (other): Doctor appointmentMedDRA releases: 2024-11 · check-in free text available
-
2021-09-21
Report sent to call center — 6 months, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-09-23
Call successfulDoes not wish to fill out VAERS report
-
2022-03-25
Survey response — 12 months, dose 1MedDRA: Foot operation, Stent placement, Toe amputation — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Surgery on right foot as I had cross over's and they amputated the second first toe. 6 weeks recovery then they doing the other foot then another 6 weeks. Another surgery to remove the other stent.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-23 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 9 — 6 months, dose 1
Symptoms: Nerothopy which causes my right leg to drag and the pain is so bad ialso suffer from a botched left hip replacement both knees bone on bone for 3 or 4 years and Vericose veins. Waist down i suffer tremendously and need someone to help me with chronic cut off by CDC
Healthcare visit (other): Doctor appointment
Release 11 — 12 months, dose 1
Symptoms: Surgery on right foot as I had cross over's and they amputated the second first toe. 6 weeks recovery then they doing the other foot then another 6 weeks. Another surgery to remove the other stent.
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 | Foot operation | · | · | ✓ |
| SD | Gait disturbance | · | · | ✓ |
| SD | Neuropathy peripheral | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Stent placement | · | · | ✓ |
| SD | Toe amputation | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release