57W-12923-91684
5 vaccinations
5 coded responses
35 check-ins
4 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 109 / NY
- Registered
- 2021-01-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-09
Registered in v-safe
-
2021-01-09
Dose 1 — Moderna
- 2021-01-15
- 2021-01-16
- 2021-01-23
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2021-01-30
Survey response — day 21, dose 1MedDRA: Abdominal discomfort, Decreased appetite, Diarrhoea, Headache, Nausea — Feeling: Good · Be unable to workFree text: On Thursday I developed a headache, queasiness, and anorexia. But no fever. I felt somewhat better the next day, but with some continued G.I. complaints, and diarrhea. Today I have not had any continuing symptoms.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-06
Dose 2 — Moderna
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2021-02-17
Health check-in — day 7, dose 2Feeling: Good · Site: Pain, Redness, Swelling, Itching · None · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
- 2021-02-20
- 2021-02-28
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2021-03-06
Survey response — day 28, dose 2MedDRA: Balance disorder, Dizziness, Feeling abnormal, Opsoclonus myoclonus — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree text: During the past week I have felt dizzy while lying in bed. Today, that increased to feeling dizzy/unstable and almost falling over while doing my normal exercise regime. I have also noticed some increased opsoclonic eye movement.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-13
Survey response — day 35, dose 2MedDRA: Dizziness postural, Loss of personal independence in daily activities — Feeling: Fair · Be unable to do your normal daily activitiesFree text: The postural dizziness which had been improving worsened last night and affected my ability to work out today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-22
- 2021-05-08
-
2021-08-10
Survey response — 6 months, dose 2MedDRA: Nasopharyngitis — Feeling: GoodFree text: Has a coldMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-12-05
Dose 3 — Moderna
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2021-12-06
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain, Itching · Headache, Fatigue or tiredness, Abdominal pain · Be unable to work or attend schoolAdult check-in
- 2021-12-08
- 2021-12-11
- 2021-12-12
- 2021-12-19
- 2021-12-26
- 2022-01-02
- 2022-01-10
- 2022-01-16
- 2022-03-06
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2022-05-29
Dose 4 — Moderna
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2022-05-30
Health check-in — days 1–6 daily, dose 4Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesAdult check-in
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2022-05-31
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-06-01
- 2022-06-02
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2022-06-03
Health check-in — days 1–6 daily, dose 4Feeling: Good · Headache, Diarrhea, Abdominal painAdult check-in
- 2022-06-05
- 2022-06-12
- 2022-06-19
- 2022-06-26
- 2022-07-03
- 2022-07-10
- 2022-11-27
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2022-12-08
Dose 5 — Pfizer-BioNTechCo-administered: Flu
-
2023-06-09
Survey response — 6 months, dose 5MedDRA: COVID-19, Dry mouth — Feeling: GoodMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-09 | Moderna | |
| 2 | 2021-02-06 | Moderna | |
| 3 | 2021-12-05 | Moderna | No |
| 4 | 2022-05-29 | Moderna | No |
| 5 | 2022-12-08 | Pfizer-BioNTech | Flu |
Free text
Release 3 — day 21, dose 1
Symptoms: On Thursday I developed a headache, queasiness, and anorexia. But no fever. I felt somewhat better the next day, but with some continued G.I. complaints, and diarrhea. Today I have not had any continuing symptoms.
Release 5 — day 28, dose 2
Symptoms: During the past week I have felt dizzy while lying in bed. Today, that increased to feeling dizzy/unstable and almost falling over while doing my normal exercise regime. I have also noticed some increased opsoclonic eye movement.
Release 5 — day 35, dose 2
Symptoms: The postural dizziness which had been improving worsened last night and affected my ability to work out today.
Release 9 — 6 months, dose 2
Symptoms: Has a cold
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 |
|---|---|---|---|---|
| SD | Abdominal discomfort | ✓ | ✓ | ✓ |
| SD | Balance disorder | ✓ | ✓ | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Decreased appetite | ✓ | ✓ | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Dizziness postural | ✓ | ✓ | ✓ |
| SD | Dry mouth | · | · | ✓ |
| SD | Feeling abnormal | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Loss of personal independence in daily activities | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | · | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SD | Opsoclonus myoclonus | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release