57S-65169-29525
4 vaccinations
10 coded responses
40 check-ins
10 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 197 / DE
- Registered
- 2021-01-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-18
Registered in v-safe
-
2021-01-18
Dose 1 — Moderna
- 2021-01-18
-
2021-01-19
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain, Nausea — Feeling: Good · Site: Pain · NauseaFree text: I got nauseous at 1 am. It lasted an hour then was gone. No GI issues the rest of the day. Pain was in the injection site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-20
Survey response — days 1–6 daily, dose 1MedDRA: Injection site discomfort — Feeling: GoodFree text: Very mild soreness at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-02-01
- 2021-02-09
- 2021-02-15
- 2021-02-22
-
2021-02-25
Dose 2 — Moderna
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-11
-
2021-03-18
Survey response — day 21, dose 2MedDRA: Allergic respiratory symptom, Eye pruritus, Upper-airway cough syndrome — Feeling: GoodFree text: Allergy symptoms - itchy eyes, post nasal dripMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-25
Survey response — day 28, dose 2MedDRA: Allergic respiratory symptom — Feeling: GoodFree text: Just allergy symptomsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-03
-
2021-04-08
Survey response — day 42, dose 2MedDRA: Headache — Feeling: GoodFree text: Headaches but it was related to use of FlonaseMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-27
- 2021-08-26
-
2021-10-22
Dose 3 — Moderna
-
2021-10-27
Survey response — days 1–6 daily, dose 3MedDRA: Pre-existing disease — Feeling: FairFree text: Cold and cough symptoms which started before the booster shotMedDRA releases: 2024-11 · check-in free text available
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Pre-existing disease — Feeling: FairFree text: Cold and cough which I had prior to boosterMedDRA releases: 2024-11 · check-in free text available
-
2021-10-29
Survey response — day 7, dose 3MedDRA: Cough, Nasopharyngitis, Pre-existing disease — Feeling: FairFree text: Cold and cough symptoms continue. Cold started prior to booster.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-05
-
2021-11-12
Survey response — day 21, dose 3MedDRA: Death of relative, Hypertension — Feeling: GoodFree text: High BP but this is due to my husband's sudden death. As I work on settling his affairs, my blood pressure goes up. I am seeing my family physician.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-19
Survey response — day 28, dose 3MedDRA: Anxiety, Death of relative, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: My husband recently passed unexpectedly. I am having anxiety over his death. · Healthcare visit (other): Family doctor office visitMedDRA releases: 2024-11 · check-in free text available
-
2021-11-19
Report sent to call center — day 28, dose 3Get care from a doctor or other healthcare professional1 call case(s)
- 2021-11-26
-
2021-11-29
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-12-03
- 2022-01-21
-
2022-03-31
Dose 4 — Moderna
- 2022-04-24
- 2022-05-18
- 2022-06-30
- 2022-10-01
- 2023-03-31
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-18 | Moderna | |
| 2 | 2021-02-25 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-03-31 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): I got nauseous at 1 am. It lasted an hour then was gone. No GI issues the rest of the day. Pain was in the injection site.
Systemic reaction (other): Very mild soreness at injection site
Release 5 — day 21, dose 2
Symptoms: Allergy symptoms - itchy eyes, post nasal drip
Release 6 — day 28, dose 2
Symptoms: Just allergy symptoms
Release 7 — day 42, dose 2
Symptoms: Headaches but it was related to use of Flonase
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Cold and cough symptoms which started before the booster shot
Systemic reaction (other): Cold and cough which I had prior to booster
Release 10 — day 7, dose 3
Systemic reaction (other): Cold and cough symptoms continue. Cold started prior to booster.
Release 10 — day 21, dose 3
Symptoms: High BP but this is due to my husband's sudden death. As I work on settling his affairs, my blood pressure goes up. I am seeing my family physician.
Release 10 — day 28, dose 3
Symptoms: My husband recently passed unexpectedly. I am having anxiety over his death.
Healthcare visit (other): Family doctor office visit
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 | Allergic respiratory symptom | ✓ | ✓ | ✓ |
| SD | Anxiety | · | · | ✓ |
| SD | Death of relative | · | · | ✓ |
| SD | Eye pruritus | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Hypertension | · | · | ✓ |
| SD | Upper-airway cough syndrome | ✓ | ✓ | ✓ |
| SRO | Cough | · | · | ✓ |
| SRO | Injection site discomfort | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Nasopharyngitis | · | · | ✓ |
| SRO | Nausea | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release