5RP-15704-67761
2 vaccinations
13 coded responses
15 check-ins
14 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 21-25
- ZIP prefix
- 976 / OR
- Registered
- 2021-09-30
- Relationship
- Self
- Race
- N/A
- Ethnicity
- N/A
Timeline
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2021-09-28
Dose 1 — Moderna
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2021-09-30
Registered in v-safe
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2021-09-30
Survey response — days 1–6 daily, dose 1MedDRA: Decreased appetite, Heart rate increased, Hot flush, Rash, Rash pruritic, Skin discolouration, Tinnitus, Vision blurred — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activitiesFree text: Increased heart rate for one minute, hot flashes, ringing in ears, random white bumps that are itchy showing up on my arms or fingers but dont stay long and only one at a time, sometimes blurry vision, loss of appetiteMedDRA releases: 2024-11 · check-in free text available
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2021-10-02
Survey response — days 1–6 daily, dose 1MedDRA: Brain fog — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Nausea, DiarrheaFree text: Foggy memoryMedDRA releases: 2024-11 · check-in free text available
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2021-10-04
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend schoolAdult check-in
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2021-10-05
Survey response — day 7, dose 1MedDRA: Rash, Rash pruritic — Feeling: Good · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaFree text: Rash/itchy on random spots on body for short periods of timeMedDRA releases: 2024-11 · check-in free text available
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2021-10-12
Survey response — day 14, dose 1MedDRA: Anxiety, Dizziness, Dry mouth, Headache — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Anxious all the time Constant headache and dizziness Dry mouthMedDRA releases: 2024-11 · check-in free text available
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2021-10-19
Survey response — day 21, dose 1MedDRA: Anxiety, Disturbance in attention — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Anxious (two anxiety attacks - not normal before vaccine) Trouble concentratingMedDRA releases: 2024-11 · check-in free text available
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2021-10-26
Dose 2 — Moderna
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2021-10-26
Survey response — day 0, dose 2MedDRA: Chest pain, Disturbance in attention, Dizziness, Dyspepsia, Dyspnoea, Hypoaesthesia, Peripheral coldness, Urticaria — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesFree text: Random hives randomly showing up (face currently), trouble concentrating, dizziness, burning sensations in chest and stomach, shortness of breath, cold/numb feetMedDRA releases: 2024-11 · check-in free text available
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2021-10-27
Survey response — days 1–6 daily, dose 2MedDRA: Back pain, Chest discomfort, Dizziness, Middle insomnia, Vision blurred — Feeling: Poor · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Heavy and tight feeling chest, major back pain, waking up constantly during the night with fuzzy vision and dizzinessMedDRA releases: 2024-11 · check-in free text available
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2021-10-28
Survey response — days 1–6 daily, dose 2MedDRA: Back pain, Decreased appetite, Dizziness, Memory impairment, Migraine, Sleep disorder — Feeling: Fair · Site: Pain, Redness · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Memory fog, sleep problems, dizziness, migraine, back pain, loss of appetiteMedDRA releases: 2024-11 · check-in free text available
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2021-11-02
Survey response — day 7, dose 2MedDRA: Abdominal pain lower — Feeling: Good · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal painFree text: Major abdominal pain on lower right sideMedDRA releases: 2024-11 · check-in free text available
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2021-11-09
Survey response — day 14, dose 2MedDRA: Brain fog, Constipation, Diarrhoea — Feeling: GoodFree text: Diarrhea/constipation one or the other Major brain fogMedDRA releases: 2024-11 · check-in free text available
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2021-11-16
Survey response — day 21, dose 2MedDRA: Amnesia — Feeling: GoodFree text: Memory loss (short and long term - example: I couldn't remember the address of the house I just moved out of in August and I lived there for 2 -2.5 years).MedDRA releases: 2024-11 · check-in free text available
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2021-11-23
Health check-in — day 28, dose 2Feeling: Fair · Be unable to do your normal daily activitiesFree text: Brain fog - cant remember things even things I did a couple seconds ago.Adult check-in · check-in free text available
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2021-11-30
Survey response — day 35, dose 2MedDRA: Anxiety, Chest discomfort, Chest pain, Dyspnoea, Hot flush — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Increased anxious feelings, chest pain/compressed feeling chest, trouble breathing (unconsciously - have to remind myself to), hot flashesMedDRA releases: 2024-11 · check-in free text available
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2021-12-07
Survey response — day 42, dose 2MedDRA: Adverse reaction — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Same as last check in and just as bad.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-09-28 | Moderna | No |
| 2 | 2021-10-26 | Moderna | No |
Free text
Release 9 — days 1–6 daily, dose 1
Systemic reaction (other): Increased heart rate for one minute, hot flashes, ringing in ears, random white bumps that are itchy showing up on my arms or fingers but dont stay long and only one at a time, sometimes blurry vision, loss of appetite
Systemic reaction (other): Foggy memory
Release 10 — day 7, dose 1
Systemic reaction (other): Rash/itchy on random spots on body for short periods of time
Release 10 — day 14, dose 1
Symptoms: Anxious all the time Constant headache and dizziness Dry mouth
Release 10 — day 21, dose 1
Symptoms: Anxious (two anxiety attacks - not normal before vaccine) Trouble concentrating
Release 10 — day 0, dose 2
Systemic reaction (other): Random hives randomly showing up (face currently), trouble concentrating, dizziness, burning sensations in chest and stomach, shortness of breath, cold/numb feet
Release 10 — days 1–6 daily, dose 2
Systemic reaction (other): Heavy and tight feeling chest, major back pain, waking up constantly during the night with fuzzy vision and dizziness
Systemic reaction (other): Memory fog, sleep problems, dizziness, migraine, back pain, loss of appetite
Release 10 — day 7, dose 2
Systemic reaction (other): Major abdominal pain on lower right side
Release 10 — day 14, dose 2
Symptoms: Diarrhea/constipation one or the other Major brain fog
Release 10 — day 21, dose 2
Symptoms: Memory loss (short and long term - example: I couldn't remember the address of the house I just moved out of in August and I lived there for 2 -2.5 years).
Release 10 — day 35, dose 2
Symptoms: Increased anxious feelings, chest pain/compressed feeling chest, trouble breathing (unconsciously - have to remind myself to), hot flashes
Release 10 — day 42, dose 2
Symptoms: Same as last check in and just as bad.
Release 12 — day 28, dose 2
Symptoms: Brain fog - cant remember things even things I did a couple seconds ago.
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 | Adverse reaction | · | · | ✓ |
| SD | Amnesia | · | · | ✓ |
| SD | Anxiety | · | · | ✓ |
| SD | Brain fog | · | · | ✓ |
| SD | Chest discomfort | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Constipation | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Disturbance in attention | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Dry mouth | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Hot flush | · | · | ✓ |
| SRO | Abdominal pain lower | · | · | ✓ |
| SRO | Back pain | · | · | ✓ |
| SRO | Brain fog | · | · | ✓ |
| SRO | Chest discomfort | · | · | ✓ |
| SRO | Chest pain | · | · | ✓ |
| SRO | Decreased appetite | · | · | ✓ |
| SRO | Disturbance in attention | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Dyspepsia | · | · | ✓ |
| SRO | Dyspnoea | · | · | ✓ |
| SRO | Heart rate increased | · | · | ✓ |
| SRO | Hot flush | · | · | ✓ |
| SRO | Hypoaesthesia | · | · | ✓ |
| SRO | Memory impairment | · | · | ✓ |
| SRO | Middle insomnia | · | · | ✓ |
| SRO | Migraine | · | · | ✓ |
| SRO | Peripheral coldness | · | · | ✓ |
| SRO | Rash | · | · | ✓ |
| SRO | Rash pruritic | · | · | ✓ |
| SRO | Skin discolouration | · | · | ✓ |
| SRO | Sleep disorder | · | · | ✓ |
| SRO | Tinnitus | · | · | ✓ |
| SRO | Urticaria | · | · | ✓ |
| SRO | Vision blurred | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release