5AR-18314-15183
2 vaccinations
3 coded responses
17 check-ins
3 free-text entries
1 call case
- Sex
- —
- Age at first dose
- 66+
- ZIP prefix
- 134 / NY
- Registered
- 2021-02-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-19
Dose 1 — Moderna
-
2021-02-04
Registered in v-safe
- 2021-02-04
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2021-02-09
Survey response — day 21, dose 1MedDRA: Immunisation reaction, Rash, Rash pruritic — Feeling: GoodFree text: This was actually for 1 week after my vaccination that I didn't report. After 1 week I developed an itchy rash on the upper arm of where I received the shot. I believe this is called covid arm. The rash went away after a few days.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-16
Dose 2 — Moderna
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2021-02-16
Survey response — day 0, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: I just received the 2nd shot a few minutes ago.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-02-18
- 2021-02-19
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-05-19
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2021-08-20
Survey response — 6 months, dose 2MedDRA: Anaphylactic shock, Arthropod sting, Emergency care, Near death experience — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: I don't know if it's related to me getting the vaccine but on July 2nd I was twice bitten in the face by a wasp and went into severe anaphylaxis shock. I almost died. Ambulance took me to the hospital. Never had a reaction before. Vaccine related?MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-20
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-26
- 2021-08-30
- 2022-02-18
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-19 | Moderna | |
| 2 | 2021-02-16 | Moderna |
Call center
1 call center case
1 unsuccessful
Free text
Release 3 — day 21, dose 1
Symptoms: This was actually for 1 week after my vaccination that I didn't report. After 1 week I developed an itchy rash on the upper arm of where I received the shot. I believe this is called covid arm. The rash went away after a few days.
Release 4 — day 0, dose 2
Systemic reaction (other): I just received the 2nd shot a few minutes ago.
Release 9 — 6 months, dose 2
Symptoms: I don't know if it's related to me getting the vaccine but on July 2nd I was twice bitten in the face by a wasp and went into severe anaphylaxis shock. I almost died. Ambulance took me to the hospital. Never had a reaction before. Vaccine related? cut off by CDC
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 | Anaphylactic shock | ✓ | · | ✓ |
| SD | Arthropod sting | ✓ | · | ✓ |
| SD | Emergency care | ✓ | · | ✓ |
| SD | Immunisation reaction | ✓ | ✓ | ✓ |
| SD | Near death experience | ✓ | · | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Rash pruritic | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release