5L4-16563-78172
5 vaccinations
3 coded responses
53 check-ins
3 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 194 / PA
- Registered
- 2021-04-17
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-20
Dose 1 — Moderna
-
2021-04-17
Registered in v-safe
-
2021-04-17
Dose 2 — Moderna
-
2021-04-17
Survey response — day 0, dose 2MedDRA: Chest pain, Immediate post-injection reaction, Medical counselling — Feeling: GoodFree text: A twinge on the left side of my chest a half hour after I receive my second dose other covid-19 shot. It lasts for an hour, I notified the pharmacist I went back to Rite Aid with the half hour of receiving the shot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-18
- 2021-04-19
- 2021-04-20
- 2021-04-21
-
2021-04-22
Survey response — days 1–6 daily, dose 2MedDRA: Epistaxis, Thrombosis — Feeling: GoodFree text: Yesterday after I had notified you I experience heavy nosebleeds and clotting between the hours of 7:15 p.m. and 9:10 p.m.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-23
- 2021-04-24
- 2021-05-01
- 2021-05-08
- 2021-05-17
-
2021-05-22
Survey response — day 35, dose 2MedDRA: Epistaxis, Thrombosis — Feeling: GoodFree text: On May 20, 2021 I had a nosebleed at 4:44-4:47 a.m. it was bright red and some clotting.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-29
- 2021-07-17
- 2021-10-18
-
2021-12-21
Dose 3 — Moderna
- 2021-12-22
- 2021-12-23
- 2021-12-24
- 2021-12-25
- 2021-12-26
- 2021-12-27
- 2021-12-28
- 2022-01-04
- 2022-01-11
- 2022-01-18
- 2022-01-25
- 2022-02-01
- 2022-03-22
-
2022-04-21
Dose 4 — Moderna
- 2022-04-21
- 2022-04-22
- 2022-04-23
- 2022-04-24
- 2022-04-25
- 2022-04-26
- 2022-04-27
- 2022-04-28
- 2022-05-05
- 2022-05-12
- 2022-05-19
- 2022-05-26
- 2022-06-02
- 2022-07-21
- 2022-10-21
-
2022-10-27
Dose 5 — Moderna
- 2022-10-30
- 2022-11-01
- 2022-11-02
- 2022-11-03
- 2022-11-11
- 2022-11-17
- 2022-11-24
- 2022-12-01
- 2022-12-08
- 2023-01-28
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-20 | Moderna | |
| 2 | 2021-04-17 | Moderna | |
| 3 | 2021-12-21 | Moderna | No |
| 4 | 2022-04-21 | Moderna | No |
| 5 | 2022-10-27 | Moderna | No |
Free text
Release 7 — day 0, dose 2
Systemic reaction (other): A twinge on the left side of my chest a half hour after I receive my second dose other covid-19 shot. It lasts for an hour, I notified the pharmacist I went back to Rite Aid with the half hour of receiving the shot.
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Yesterday after I had notified you I experience heavy nosebleeds and clotting between the hours of 7:15 p.m. and 9:10 p.m.
Release 8 — day 35, dose 2
Symptoms: On May 20, 2021 I had a nosebleed at 4:44-4:47 a.m. it was bright red and some clotting.
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 | Epistaxis | ✓ | ✓ | ✓ |
| SD | Thrombosis | ✓ | ✓ | ✓ |
| SRO | Chest pain | ✓ | ✓ | ✓ |
| SRO | Epistaxis | ✓ | ✓ | ✓ |
| SRO | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SRO | Medical counselling | ✓ | ✓ | ✓ |
| SRO | Thrombosis | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release