5T3-86132-04051
4 vaccinations
19 coded responses
23 check-ins
18 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 921 / CA
- Registered
- 2021-11-25
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-02-02
Dose 1 — Moderna
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2021-03-02
Dose 2 — Moderna
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2021-11-24
Dose 3 — Moderna
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2021-11-25
Registered in v-safe
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2021-11-25
Survey response — days 1–6 daily, dose 3MedDRA: Dizziness — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: I was very dizzyMedDRA releases: 2024-11 · check-in free text available
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2021-11-26
Survey response — days 1–6 daily, dose 3MedDRA: Dizziness, Vertigo — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: Vertigo dizzinessMedDRA releases: 2024-11 · check-in free text available
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2021-11-27
Survey response — days 1–6 daily, dose 3MedDRA: Decreased appetite, Dizziness, Fatigue, Pre-existing disease, Somnolence — Feeling: Poor · Site: Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Already have Vertigo,, Booster added more than usual dizziness. Some loss in appetite. Very tired and sleepy.MedDRA releases: 2024-11 · check-in free text available
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2021-11-29
Survey response — days 1–6 daily, dose 3MedDRA: Dry mouth, Dry skin, Pruritus, Vertigo — Feeling: Fair · Site: Redness, Swelling · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Dry mouth, itchy dry skin and VertigoMedDRA releases: 2024-11 · check-in free text available
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2021-11-30
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — Feeling: Fair · Site: Itching · Chills, Joint pains, Muscle or body aches, Fatigue or tirednessFree text: Same as earlierMedDRA releases: 2024-11 · check-in free text available
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2021-12-01
Survey response — day 7, dose 3MedDRA: Hypoacusis — Feeling: Fair · Site: Swelling, Itching · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesFree text: Hearing fluctuates, left sounds muffled at timesMedDRA releases: 2024-11 · check-in free text available
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2021-12-08
Survey response — day 14, dose 3MedDRA: Dry skin, Injection site pain, Pruritus — Feeling: FairFree text: Some dry skin and periodically itchy skin and slight pain in injection area when I lay on left arm.MedDRA releases: 2024-11 · check-in free text available
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2021-12-15
Survey response — day 21, dose 3MedDRA: Muscular weakness, Musculoskeletal stiffness, Myalgia, Pain, Skin wrinkling — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Left arm upper muscle weakness, stiffness and throbbing at times. Arm looks different and smaller than right arm with a lot more wrinkles.MedDRA releases: 2024-11 · check-in free text available
- 2021-12-22
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2021-12-29
Survey response — day 35, dose 3MedDRA: Chills, Dry skin, Headache, Productive cough, Skin exfoliation — Feeling: FairFree text: Bad headache, coughing pleam, chills and very dry scaly skin.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-05
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2022-02-24
Survey response — 3 months, dose 3MedDRA: Injection site pain, Injection site reaction, Muscle spasms, Pain — Feeling: FairFree text: Throbbing Pain periodic in left arm at injection site with some muscle spasms.MedDRA releases: 2024-11 · check-in free text available
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2022-05-25
Survey response — 6 months, dose 3MedDRA: Arthralgia, Decreased appetite, Fatigue, Headache, Muscle atrophy, Night sweats, Pain in extremity, Poor quality sleep, Skin irritation, Skin wrinkling — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Tired, not sleeping well, more like Naps. Night sweats, left arm and shoulder aches, lots of muscle loss and wrinkle skin, less appetite and headache and irritation.MedDRA releases: 2024-11 · check-in free text available
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2022-07-20
Dose 4 — ModernaCo-administered: Shingles
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2022-07-25
Survey response — days 1–6 daily, dose 4MedDRA: Pain in extremity — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: Left upper arm is very much sore, hurting from both Shingles shot and 2nd Booster.MedDRA releases: 2024-11 · check-in free text available
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2022-07-26
Survey response — days 1–6 daily, dose 4MedDRA: Condition aggravated, Pain in extremity, Pre-existing disease — Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Nagging ache in lower legs, have Degenerative Disc in lower back and spine aggravated when standing, walking and sitting.MedDRA releases: 2024-11 · check-in free text available
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2022-07-27
Health check-in — day 7, dose 4Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection siteAdult check-in
- 2022-08-03
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2022-08-10
Survey response — day 21, dose 4MedDRA: Decreased appetite, Dizziness, Fatigue, Headache, Night sweats, Pain, Vascular pain, Vasodilatation — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Lot more dizziness, headaches some loss of appetite and fatigue with swelling and throbbing of varicose veins behind the knees mostly when I have to walk or stand a lot. Some nite sweating.MedDRA releases: 2024-11 · check-in free text available
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2022-08-17
Survey response — day 28, dose 4MedDRA: Dizziness, Fatigue, Headache, Hyperhidrosis, Somnolence — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Maybe from Hot weather or Vertigo but dizzy, sweating, tired and sleepy with a massive headache at timesMedDRA releases: 2024-11 · check-in free text available
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2022-08-24
Survey response — day 35, dose 4MedDRA: Abdominal pain upper, Decreased appetite, Diarrhoea, Dizziness, Fatigue, Injection site pain, Pain — Feeling: FairFree text: Fatigue, little dizzy, much less appetite, loose bowles stomach cramping. Arm throbs at injection site.MedDRA releases: 2024-11 · check-in free text available
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2022-09-01
Survey response — day 42, dose 4MedDRA: Asthenia, Fatigue, Influenza, Nasopharyngitis, Pain, Sneezing, Somnolence — Feeling: Poor · Be unable to do your normal daily activitiesFree text: My everything is hurting and throbbing. Very little energy, very much tired and drowsy, some sneezing.. feeling like a cold or the flu. Others are feeling the same.MedDRA releases: 2024-11 · check-in free text available
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2022-10-21
Survey response — 3 months, dose 4MedDRA: Unevaluable event — 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 consultationFree text: Possible food poisoning in September.MedDRA releases: 2024-11 · check-in free text available
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2022-10-21
Report sent to call center — 3 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)
- 2022-10-24
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2022-10-24
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2023-01-18
Survey response — 6 months, dose 4MedDRA: Alopecia, Faeces discoloured, Injected limb mobility decreased, Injection site pain, Injection site reaction, Musculoskeletal stiffness, Sleep disorder, Weight decreased — Feeling: Poor · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-02 | Moderna | No |
| 2 | 2021-03-02 | Moderna | No |
| 3 | 2021-11-24 | Moderna | No |
| 4 | 2022-07-20 | Moderna | Shingles |
Call center
1 call center case
1 successful
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): I was very dizzy
Systemic reaction (other): Vertigo dizziness
Systemic reaction (other): Already have Vertigo,, Booster added more than usual dizziness. Some loss in appetite. Very tired and sleepy.
Systemic reaction (other): Dry mouth, itchy dry skin and Vertigo
Systemic reaction (other): Same as earlier
Release 10 — day 7, dose 3
Systemic reaction (other): Hearing fluctuates, left sounds muffled at times
Release 10 — day 14, dose 3
Symptoms: Some dry skin and periodically itchy skin and slight pain in injection area when I lay on left arm.
Release 10 — day 21, dose 3
Symptoms: Left arm upper muscle weakness, stiffness and throbbing at times. Arm looks different and smaller than right arm with a lot more wrinkles.
Release 10 — day 35, dose 3
Symptoms: Bad headache, coughing pleam, chills and very dry scaly skin.
Release 11 — 3 months, dose 3
Symptoms: Throbbing Pain periodic in left arm at injection site with some muscle spasms.
Release 11 — 6 months, dose 3
Symptoms: Tired, not sleeping well, more like Naps. Night sweats, left arm and shoulder aches, lots of muscle loss and wrinkle skin, less appetite and headache and irritation.
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Left upper arm is very much sore, hurting from both Shingles shot and 2nd Booster.
Systemic reaction (other): Nagging ache in lower legs, have Degenerative Disc in lower back and spine aggravated when standing, walking and sitting.
Release 12 — day 21, dose 4
Symptoms: Lot more dizziness, headaches some loss of appetite and fatigue with swelling and throbbing of varicose veins behind the knees mostly when I have to walk or stand a lot. Some nite sweating.
Release 12 — day 28, dose 4
Symptoms: Maybe from Hot weather or Vertigo but dizzy, sweating, tired and sleepy with a massive headache at times
Release 12 — day 35, dose 4
Symptoms: Fatigue, little dizzy, much less appetite, loose bowles stomach cramping. Arm throbs at injection site.
Release 12 — day 42, dose 4
Symptoms: My everything is hurting and throbbing. Very little energy, very much tired and drowsy, some sneezing.. feeling like a cold or the flu. Others are feeling the same.
Release 12 — 3 months, dose 4
Symptoms: Possible food poisoning in September.
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 | Abdominal pain upper | · | · | ✓ |
| SD | Alopecia | · | · | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Asthenia | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Decreased appetite | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Dry skin | · | · | ✓ |
| SD | Faeces discoloured | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Hyperhidrosis | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Injected limb mobility decreased | · | · | ✓ |
| SD | Injection site pain | · | · | ✓ |
| SD | Injection site reaction | · | · | ✓ |
| SD | Muscle atrophy | · | · | ✓ |
| SD | Muscle spasms | · | · | ✓ |
| SD | Muscular weakness | · | · | ✓ |
| SD | Musculoskeletal stiffness | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Night sweats | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Poor quality sleep | · | · | ✓ |
| SD | Productive cough | · | · | ✓ |
| SD | Pruritus | · | · | ✓ |
| SD | Skin exfoliation | · | · | ✓ |
| SD | Skin irritation | · | · | ✓ |
| SD | Skin wrinkling | · | · | ✓ |
| SD | Sleep disorder | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Somnolence | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SD | Vascular pain | · | · | ✓ |
| SD | Vasodilatation | · | · | ✓ |
| SD | Weight decreased | · | · | ✓ |
| SRO | Condition aggravated | · | · | ✓ |
| SRO | Decreased appetite | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Dry mouth | · | · | ✓ |
| SRO | Dry skin | · | · | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Hypoacusis | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Pruritus | · | · | ✓ |
| SRO | Somnolence | · | · | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
| SRO | Vertigo | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release