5HN-66876-37297
4 vaccinations
6 coded responses
20 check-ins
6 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 983 / WA
- Registered
- 2021-03-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-14
Dose 1 — Moderna
-
2021-02-11
Dose 2 — Moderna
-
2021-03-30
Registered in v-safe
- 2021-03-30
- 2021-08-12
-
2021-08-24
Dose 3 — Moderna
- 2021-11-23
-
2022-02-24
Survey response — 6 months, dose 3MedDRA: Bronchitis, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Bronchitis · Healthcare visit (other): Rheumatologist in personMedDRA releases: 2024-11 · check-in free text available
-
2022-02-24
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2022-02-28
Call successfulCompleted over the phone
-
2022-05-27
Dose 4 — Pfizer-BioNTech
- 2022-05-27
- 2022-05-28
-
2022-05-29
Survey response — days 1–6 daily, dose 4MedDRA: Injection site pain, Injection site swelling — Feeling: GoodFree text: Feel great- just a bit sore and swollen first 48 hours at injection site but could still sleep on itMedDRA releases: 2024-11 · check-in free text available
-
2022-05-30
Survey response — days 1–6 daily, dose 4MedDRA: Fatigue, Pre-existing disease — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Moderate fatigue but did my weekly Tocilzumab 162 mg injection last night- more tired than usual todayMedDRA releases: 2024-11 · check-in free text available
- 2022-05-31
- 2022-06-01
-
2022-06-02
Survey response — days 1–6 daily, dose 4MedDRA: Adverse reaction — Feeling: Good · Diarrhea, Abdominal painFree text: Began last night at 10 pm but could have been Mexican food..MedDRA releases: 2024-11 · check-in free text available
- 2022-06-03
- 2022-06-11
- 2022-06-17
-
2022-06-27
Survey response — day 28, dose 4MedDRA: Oropharyngeal pain — Feeling: GoodFree text: Sore throatMedDRA releases: 2024-11 · check-in free text available
- 2022-07-02
- 2022-07-08
- 2022-08-26
-
2022-11-26
Survey response — 6 months, dose 4MedDRA: Adverse drug reaction, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Mycrobacteria lung infection w 2 fungus due to my immunosuppresants · Healthcare visit (other): Bronchoscope, multiple appointments w rheumatologists, pulmonologists, infectious diseaseMedDRA releases: 2024-11 · check-in free text available
-
2022-11-26
Report sent to call center — 6 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-11-29
Call successfulDoes not wish to fill out VAERS report
- 2023-05-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-14 | Moderna | |
| 2 | 2021-02-11 | Moderna | |
| 3 | 2021-08-24 | Moderna | No |
| 4 | 2022-05-27 | Pfizer-BioNTech | No |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 1
Free text
Release 11 — 6 months, dose 3
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Feel great- just a bit sore and swollen first 48 hours at injection site but could still sleep on it
Systemic reaction (other): Moderate fatigue but did my weekly Tocilzumab 162 mg injection last night- more tired than usual today
Systemic reaction (other): Began last night at 10 pm but could have been Mexican food..
Release 12 — day 28, dose 4
Symptoms: Sore throat
Release 12 — 6 months, dose 4
Symptoms: Mycrobacteria lung infection w 2 fungus due to my immunosuppresants
Healthcare visit (other): Bronchoscope, multiple appointments w rheumatologists, pulmonologists, infectious disease
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 | Adverse drug reaction | · | · | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SRO | Adverse reaction | · | · | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Injection site swelling | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release