57V-11715-25204
2 vaccinations
4 coded responses
25 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 592 / MT
- Registered
- 2021-02-05
- Relationship
- Self
- Race
- American Indian or Alaska Native
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-04
Dose 1 — Moderna
-
2021-02-05
Registered in v-safe
- 2021-02-05
-
2021-02-06
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-07
-
2021-02-08
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Itching · Abdominal painAdult check-in
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-18
-
2021-02-25
Survey response — day 21, dose 1MedDRA: Office visit, Tympanic membrane perforation — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: I have perforated ear drums. I was given amoxicillin 3 xs a day for 10 days. · Healthcare visit (other): Hpdp nurse practitioner @ the school where I work.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-25
Report sent to call center — day 21, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-03-04
Dose 2 — Moderna
- 2021-03-04
-
2021-03-05
Survey response — days 1–6 daily, dose 2MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: Woke up with a little sore throat but Im better now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
-
2021-04-08
Survey response — day 35, dose 2MedDRA: Abdominal pain upper, Arthralgia, Chills, Diarrhoea, Night sweats, Tension headache — Feeling: Fair · Be unable to work or attend schoolFree text: Stomach pain and cramping had diarrhea,chills tension headache, joints hurt. This all started on Monday 4/5/21 the night before I woke up drenched in sweat.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-15
- 2021-06-05
- 2021-09-02
- 2021-12-21
- 2021-12-27
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2022-03-06
Survey response — 12 months, dose 2MedDRA: Arthralgia, Cough, Headache, Office visit, Oropharyngeal pain — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Achy joints, headache, sore throat, dry cough · Healthcare visit (other): Hpdp nurse practitionerMedDRA releases: 2024-11 · check-in free text available
-
2022-03-06
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-03-09
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Moderna | |
| 2 | 2021-03-04 | Moderna |
Call center
2 call center cases
2 unsuccessful
1 wait over 3 months for a first call
Free text
Release 4 — day 21, dose 1
Symptoms: I have perforated ear drums. I was given amoxicillin 3 xs a day for 10 days.
Healthcare visit (other): Hpdp nurse practitioner @ the school where I work.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Woke up with a little sore throat but Im better now.
Release 7 — day 35, dose 2
Symptoms: Stomach pain and cramping had diarrhea,chills tension headache, joints hurt. This all started on Monday 4/5/21 the night before I woke up drenched in sweat.
Release 11 — 12 months, dose 2
Symptoms: Achy joints, headache, sore throat, dry cough
Healthcare visit (other): Hpdp nurse practitioner
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 | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Arthralgia | ✓ | ✓ | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Night sweats | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Tension headache | ✓ | ✓ | ✓ |
| SD | Tympanic membrane perforation | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release