55A-24911-10641
1 vaccination
8 coded responses
8 check-ins
8 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 787 / TX
- Registered
- 2022-01-13
- Relationship
- Self
- Race
- Multiracial
- Ethnicity
- Not Hispanic or Latino
Registered dependents
RW9-24217-08405
Child or adolescent in my care · Male · 2022-01-18
MJM-18356-38834
Child or adolescent in my care · Female · 2022-01-18
Timeline
-
2022-01-12
Dose 1 — Moderna
-
2022-01-13
Registered in v-safe
-
2022-01-13
Survey response — days 1–6 daily, dose 1MedDRA: Back pain, Burning sensation, Dizziness, Dyspnoea, Flank pain, Hyperhidrosis, Muscular weakness, Pain, Painful respiration, Palpitations, Pulmonary pain, Tremor, Unevaluable event — Feeling: Poor · Site: Pain, Redness · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): Pain in back LL side. Let flank pain. Chest pain/ pain in lungs when breathing. Deep Burning, throbbing, constant. Shaking Sweating Shortness of breath Racing Heart Dizziness Arms/hands/ Legs weak, · Healthcare visit (other): Appointment scheduled.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-13
Report sent to call center — days 1–6 daily, dose 1Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
-
2022-01-14
Survey response — days 1–6 daily, dose 1MedDRA: Back pain, Flank pain, Musculoskeletal chest pain, Pain in extremity, Painful respiration, Pulmonary pain — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Pain in lungs when breathing. Pain in Lower R flank, pain in ribs, pain in legs that fell like big clots moving, pain in back between shoulder blades.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-15
Survey response — days 1–6 daily, dose 1MedDRA: Back pain, Chest pain, Flank pain, Flushing, Hyperhidrosis, Urticaria — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Hives on face and chest, feeling flushed, sweating, pain in chest, pain in back. Right flank pain.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-16
Survey response — days 1–6 daily, dose 1MedDRA: Chest pain, Flank pain, Muscle spasms — Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Right flank pain, chest pain, leg/muscle crampsMedDRA releases: 2024-11 · check-in free text available
-
2022-01-17
Survey response — days 1–6 daily, dose 1MedDRA: Burning sensation, Flushing, Swelling face, Urticaria — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Flushed swollen face with hives burning to the touch.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-18
Survey response — days 1–6 daily, dose 1MedDRA: Flushing, Hyperhidrosis, Myalgia, Rash, Rash erythematous — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: red, flushed rash over face and torso. Pain in leg muscles. SweatingMedDRA releases: 2024-11 · check-in free text available
-
2022-01-19
Survey response — day 7, dose 1MedDRA: Erythema, Flank pain, Flushing, Swelling face — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Flushed red swollen face, Right flank painMedDRA releases: 2024-11 · check-in free text available
- 2022-01-21
-
2022-02-09
Survey response — day 28, dose 1MedDRA: Hepatic enzyme increased, Urticaria — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Elevated liver enzymes for 3 weeks. Hives on face for 3 weeks.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-01-12 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
Release 10 — days 1–6 daily, dose 1
Systemic reaction (other): Pain in back LL side. Let flank pain. Chest pain/ pain in lungs when breathing. Deep Burning, throbbing, constant. Shaking Sweating Shortness of breath Racing Heart Dizziness Arms/hands/ Legs weak,
Healthcare visit (other): Appointment scheduled.
Systemic reaction (other): Pain in lungs when breathing. Pain in Lower R flank, pain in ribs, pain in legs that fell like big clots moving, pain in back between shoulder blades.
Systemic reaction (other): Hives on face and chest, feeling flushed, sweating, pain in chest, pain in back. Right flank pain.
Systemic reaction (other): Right flank pain, chest pain, leg/muscle cramps
Systemic reaction (other): Flushed swollen face with hives burning to the touch.
Systemic reaction (other): red, flushed rash over face and torso. Pain in leg muscles. Sweating
Release 10 — day 7, dose 1
Systemic reaction (other): Flushed red swollen face, Right flank pain
Release 11 — day 28, dose 1
Symptoms: Elevated liver enzymes for 3 weeks. Hives on face for 3 weeks.
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 | Unevaluable event | · | · | ✓ |
| SD | Hepatic enzyme increased | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
| SRO | Back pain | · | · | ✓ |
| SRO | Burning sensation | · | · | ✓ |
| SRO | Chest pain | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Dyspnoea | · | · | ✓ |
| SRO | Erythema | · | · | ✓ |
| SRO | Flank pain | · | · | ✓ |
| SRO | Flushing | · | · | ✓ |
| SRO | Hyperhidrosis | · | · | ✓ |
| SRO | Muscle spasms | · | · | ✓ |
| SRO | Muscular weakness | · | · | ✓ |
| SRO | Musculoskeletal chest pain | · | · | ✓ |
| SRO | Myalgia | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
| SRO | Painful respiration | · | · | ✓ |
| SRO | Palpitations | · | · | ✓ |
| SRO | Pulmonary pain | · | · | ✓ |
| SRO | Rash | · | · | ✓ |
| SRO | Rash erythematous | · | · | ✓ |
| SRO | Swelling face | · | · | ✓ |
| SRO | Tremor | · | · | ✓ |
| SRO | Urticaria | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release