5HL-22979-33110
2 vaccinations
5 coded responses
24 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 109 / NY
- Registered
- 2021-04-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-01
Registered in v-safe
-
2021-04-01
Dose 1 — Moderna
- 2021-04-01
- 2021-04-02
-
2021-04-03
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Good · Site: Pain · DiarrheaFree text: But this may be because I had coffee for the first time in a long timeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-08
- 2021-04-15
- 2021-04-22
-
2021-04-29
Dose 2 — Moderna
- 2021-04-29
-
2021-04-30
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-05-01
Survey response — days 1–6 daily, dose 2MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Good · Site: PainFree text: Pain/ swollen gland in armpit of arm where injection wasMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-02
Survey response — days 1–6 daily, dose 2MedDRA: Discomfort — Feeling: Good · Site: PainFree text: Discomfort in armpit of arm that received shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-03
Survey response — days 1–6 daily, dose 2MedDRA: Discomfort — Feeling: Good · Site: PainFree text: Discomfort in armpit of arm that received shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-04
- 2021-05-05
- 2021-05-06
- 2021-05-13
- 2021-05-20
- 2021-05-27
- 2021-06-03
- 2021-06-12
- 2021-07-29
-
2021-10-29
Survey response — 6 months, dose 2MedDRA: Abortion spontaneous, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Miscarriage · Healthcare visit (other): Doctors visitsMedDRA releases: 2024-11 · check-in free text available
-
2021-10-29
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-11-02
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-01 | Moderna | |
| 2 | 2021-04-29 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-10-29 | Successful 2021-11-02 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): But this may be because I had coffee for the first time in a long time
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Pain/ swollen gland in armpit of arm where injection was
Systemic reaction (other): Discomfort in armpit of arm that received shot
Systemic reaction (other): Discomfort in armpit of arm that received shot
Release 10 — 6 months, dose 2
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 | Abortion spontaneous | · | · | ✓ |
| SRO | Discomfort | ✓ | ✓ | ✓ |
| SRO | Lymph node pain | ✓ | ✓ | ✓ |
| SRO | Lymphadenopathy | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release