5JY-21163-06219
4 vaccinations
6 coded responses
37 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 981 / WA
- Registered
- 2021-04-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-29
Dose 1 — Moderna
-
2021-04-01
Registered in v-safe
- 2021-04-01
- 2021-04-02
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-12
- 2021-04-19
-
2021-04-26
Dose 2 — Moderna
- 2021-04-26
-
2021-04-27
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-04-29
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-30
Survey response — days 1–6 daily, dose 2MedDRA: Oropharyngeal pain — Feeling: Good · Site: Pain · Fever · Headache, Fatigue or tirednessFree text: sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-01
- 2021-05-02
- 2021-05-03
- 2021-05-10
- 2021-05-17
- 2021-05-24
- 2021-05-31
- 2021-06-07
- 2021-07-26
- 2021-10-25
-
2021-12-11
Dose 3 — Moderna
-
2022-04-26
Survey response — 12 months, dose 2MedDRA: COVID-19 — Feeling: Good · Be unable to do your normal daily activitiesFree text: I had covid in February.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-27
Dose 4 — Moderna
- 2022-04-27
- 2022-04-28
- 2022-04-29
- 2022-04-30
- 2022-05-01
- 2022-05-02
- 2022-05-03
- 2022-05-04
- 2022-05-11
-
2022-05-18
Survey response — day 21, dose 4MedDRA: Bradycardia, Electrocardiogram T wave inversion — Feeling: GoodFree text: I was given a routine EKG and it showed a new inverted T wave and bradycardia.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-25
-
2022-07-27
Survey response — 3 months, dose 4MedDRA: COVID-19, Electrocardiogram T wave inversion, Electrocardiogram abnormal, Exercise tolerance decreased, Office visit — Feeling: GoodFree text: In February I had covid, w/ 1 month of exercise intolerance. In may found new inverted T wave on routine EKG (required before starting new meds). Cardiac stress test nl. Inverted T wave resolved on repeat EKG. Cardiology suspects it was covid relatedMedDRA releases: 2024-11 · check-in free text available
-
2022-10-26
Survey response — 6 months, dose 4MedDRA: Asthma, Nasopharyngitis, Pre-existing disease, SARS-CoV-2 test negative — Feeling: Good · 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: Had a cold (negative covid test at home x 2) and then an asthma flare related to wildfire smoke.MedDRA releases: 2024-11 · check-in free text available
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2022-10-26
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)
-
2022-10-28
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-04-27
Survey response — 12 months, dose 4MedDRA: Asthma, Influenza, Influenza virus test positive, Nasopharyngitis, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-29 | Moderna | |
| 2 | 2021-04-26 | Moderna | |
| 3 | 2021-12-11 | Moderna | No |
| 4 | 2022-04-27 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): sore throat
Release 11 — 12 months, dose 2
Symptoms: I had covid in February.
Release 11 — day 21, dose 4
Symptoms: I was given a routine EKG and it showed a new inverted T wave and bradycardia.
Release 12 — 3 months, dose 4
Symptoms: In February I had covid, w/ 1 month of exercise intolerance. In may found new inverted T wave on routine EKG (required before starting new meds). Cardiac stress test nl. Inverted T wave resolved on repeat EKG. Cardiology suspects it was covid related cut off by CDC
Release 12 — 6 months, dose 4
Symptoms: Had a cold (negative covid test at home x 2) and then an asthma flare related to wildfire smoke.
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 | Asthma | · | · | ✓ |
| SD | Bradycardia | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Electrocardiogram abnormal | · | · | ✓ |
| SD | Electrocardiogram T wave inversion | · | · | ✓ |
| SD | Exercise tolerance decreased | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Influenza virus test positive | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release