5JM-25955-03854
3 vaccinations
4 coded responses
37 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 190 / PA
- Registered
- 2021-01-22
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-22
Registered in v-safe
-
2021-01-22
Dose 1 — Moderna
- 2021-01-22
- 2021-01-23
- 2021-01-24
-
2021-01-25
Survey response — days 1–6 daily, dose 1MedDRA: Diarrhoea, Fatigue, Feeling abnormal, Pain in extremity — Feeling: Fair · Fatigue or tiredness, Nausea, DiarrheaFree text: My mild arm pain is completely gone today. But last night I started feeling unusually tired. This morning I still felt not quite myself, and then diarrhea started before lunch.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-26
- 2021-01-27
-
2021-01-28
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue, Feeling abnormal, Somnolence — Feeling: Fair · Fatigue or tirednessFree text: Since I received the shot I have fluctuated from feeling fine to being very tired and mildly foggy, just wanting to sleep. Especially in the afternoon which is not the norm for me.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-29
- 2021-02-05
- 2021-02-12
- 2021-02-19
-
2021-02-23
Dose 2 — Moderna
-
2021-02-26
Health check-in — days 1–6 daily, dose 2Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-02-27
Survey response — days 1–6 daily, dose 2MedDRA: Chills, Fatigue, Pain in extremity, Pyrexia — Feeling: GoodFree text: I had fever, chills, sore arm and fatigue the day after me vaccine #2 on 2/23. I was not sent an email from you on that day but wanted to make an accurate report.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-04-06
- 2021-05-25
- 2021-08-24
-
2021-10-25
Dose 3 — Moderna
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-08
- 2021-11-15
- 2021-11-22
- 2021-11-29
-
2021-12-08
Survey response — day 42, dose 3MedDRA: Office visit, Sinusitis — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: I have a sinus infection. · Healthcare visit (other): Doctor's office visit.MedDRA releases: 2024-11 · check-in free text available
-
2021-12-08
Report sent to call center — day 42, dose 3Get care from a doctor or other healthcare professional1 call case(s)
-
2021-12-10
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-01-26
- 2022-04-25
- 2022-10-25
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-02-23 | Moderna | |
| 3 | 2021-10-25 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): My mild arm pain is completely gone today. But last night I started feeling unusually tired. This morning I still felt not quite myself, and then diarrhea started before lunch.
Systemic reaction (other): Since I received the shot I have fluctuated from feeling fine to being very tired and mildly foggy, just wanting to sleep. Especially in the afternoon which is not the norm for me.
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): I had fever, chills, sore arm and fatigue the day after me vaccine #2 on 2/23. I was not sent an email from you on that day but wanted to make an accurate report.
Release 10 — day 42, dose 3
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 | Sinusitis | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Diarrhoea | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Somnolence | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release