5SZ-11175-01180
3 vaccinations
9 coded responses
36 check-ins
9 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 329 / FL
- Registered
- 2021-03-02
- Relationship
- Self
- Race
- White
- Ethnicity
- N/A
Timeline
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2021-03-02
Registered in v-safe
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2021-03-02
Dose 1 — Moderna
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2021-03-02
Survey response — day 0, dose 1MedDRA: Pain in extremity — Feeling: Good · Site: Pain · Muscle or body achesFree text: Only right arm sore.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-03
Survey response — days 1–6 daily, dose 1MedDRA: Ocular hyperaemia — Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessFree text: Bloodshot eyes.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-04
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-16
- 2021-03-23
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2021-03-30
Dose 2 — Moderna
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2021-03-31
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-04-01
- 2021-04-02
- 2021-04-03
- 2021-04-06
- 2021-04-13
- 2021-04-20
- 2021-04-29
- 2021-05-04
- 2021-05-11
- 2021-06-29
- 2021-09-28
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2021-10-29
Dose 3 — ModernaCo-administered: Flu:Pneumonia
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2021-10-31
Survey response — days 1–6 daily, dose 3MedDRA: Pain in extremity — Feeling: Fair · Site: Pain · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Severe soreness in upper arm.MedDRA releases: 2024-11 · check-in free text available
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2021-11-01
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fever · Chills, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-11-02
Survey response — days 1–6 daily, dose 3MedDRA: Dizziness, Hyperhidrosis — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Felt faint and was sweating. Got in A/C and felt better.MedDRA releases: 2024-11 · check-in free text available
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2021-11-03
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-11-04
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Chills, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-05
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2021-11-12
Survey response — day 14, dose 3MedDRA: Decreased appetite, Fatigue, Retching, Weight decreased — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Still have fatigue. Dry heaves in morning. Have lost 10 pounds. Eating soup mostly.MedDRA releases: 2024-11 · check-in free text available
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2021-11-19
Survey response — day 21, dose 3MedDRA: Fatigue, Headache, Sinusitis, Vomiting — Feeling: Fair · Be unable to do your normal daily activitiesFree text: I have a sinus infection and headache off and on. Still have fatigue and vomiting in the morning. Chest x-ray is clear.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-26
- 2021-12-03
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2021-12-12
Survey response — day 42, dose 3MedDRA: Sinusitis, Syncope — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Fainted a few times. I think because of a deep sinus infection. Don't think it is the vaccine.MedDRA releases: 2024-11 · check-in free text available
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2021-12-12
Report sent to call center — day 42, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2021-12-14
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2022-01-28
Survey response — 3 months, dose 3MedDRA: Dysphagia, Impaired gastric emptying, Small cell carcinoma — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Hard to swallow. I just got diagnosed with gastropareses and small cell carcinoma. Not because of vaccination.MedDRA releases: 2024-11 · check-in free text available
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2022-05-02
Survey response — 6 months, dose 3MedDRA: Small cell carcinoma — 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 consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationFree text: Small cell carcinomaMedDRA releases: 2024-11 · check-in free text available
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2022-05-02
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
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2022-05-03
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-05-03
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-10-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-02 | Moderna | |
| 2 | 2021-03-30 | Moderna | |
| 3 | 2021-10-29 | Moderna | Flu:Pneumonia |
Call center
2 call center cases
2 successful
Free text
Release 4 — day 0, dose 1
Systemic reaction (other): Only right arm sore.
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Bloodshot eyes.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Severe soreness in upper arm.
Systemic reaction (other): Felt faint and was sweating. Got in A/C and felt better.
Release 10 — day 14, dose 3
Symptoms: Still have fatigue. Dry heaves in morning. Have lost 10 pounds. Eating soup mostly.
Release 10 — day 21, dose 3
Symptoms: I have a sinus infection and headache off and on. Still have fatigue and vomiting in the morning. Chest x-ray is clear.
Release 10 — day 42, dose 3
Symptoms: Fainted a few times. I think because of a deep sinus infection. Don't think it is the vaccine.
Release 11 — 3 months, dose 3
Symptoms: Hard to swallow. I just got diagnosed with gastropareses and small cell carcinoma. Not because of vaccination.
Release 11 — 6 months, dose 3
Symptoms: Small cell carcinoma
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 | Decreased appetite | · | · | ✓ |
| SD | Dysphagia | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Impaired gastric emptying | · | · | ✓ |
| SD | Retching | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SD | Small cell carcinoma | · | · | ✓ |
| SD | Syncope | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
| SD | Weight decreased | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Hyperhidrosis | · | · | ✓ |
| SRO | Ocular hyperaemia | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release