5TJ-22831-21878
4 vaccinations
6 coded responses
44 check-ins
6 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 088 / NJ
- Registered
- 2020-12-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-28
Registered in v-safe
-
2020-12-28
Dose 1 — Moderna
- 2020-12-28
- 2020-12-29
- 2020-12-30
- 2020-12-31
- 2021-01-01
- 2021-01-02
- 2021-01-03
- 2021-01-05
- 2021-01-11
- 2021-01-18
-
2021-01-25
Dose 2 — Moderna
- 2021-01-25
-
2021-01-26
Survey response — days 1–6 daily, dose 2MedDRA: Injection site pain — Feeling: GoodFree text: Just soreness in upper arm muscle injection site, nothing unusual after a vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-27
- 2021-01-28
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
-
2021-02-08
Survey response — day 14, dose 2MedDRA: Osteoarthritis — Feeling: GoodFree text: Osteoarthritis flare up in fingers, doubtful is related to the vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-15
- 2021-02-22
- 2021-03-01
- 2021-03-08
- 2021-04-26
-
2021-07-26
Survey response — 6 months, dose 2MedDRA: Taste disorder — Feeling: GoodFree text: Intermittent noticing taste is off sometimes, not sure if related to vaccine at all, and it's not consistentMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-10-24
Dose 3 — Moderna
- 2021-10-24
- 2021-10-25
-
2021-10-26
Survey response — days 1–6 daily, dose 3MedDRA: Office visit, Vitreous floaters — Feeling: Fair · Site: Pain · Headache · Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): New floater in right vision field · Healthcare visit (other): Going to eye Dr. to have eye checked, make sure no serious issue with new visual floaterMedDRA releases: 2024-11 · check-in free text available
-
2021-10-26
Report sent to call center — days 1–6 daily, dose 3Get care from a doctor or other healthcare professional1 call case(s)
-
2021-10-27
Survey response — days 1–6 daily, dose 3MedDRA: Office visit, Retinal detachment, Vitreous injury — Feeling: Good · Site: Pain · Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): Unrelated most probably, but have developed a spontaneous ocular vitruous tear with retinal detachment since receiving my booster vaccine.e · Healthcare visit (other): Opthalmologist in office visit, after which a retina surgical visit appointmen now is scheduled.tMedDRA releases: 2024-11 · check-in free text available
-
2021-10-27
Report sent to call center — days 1–6 daily, dose 3Get care from a doctor or other healthcare professional1 call case(s)
- 2021-10-28
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-07
- 2021-11-14
- 2021-11-21
- 2021-11-28
- 2021-12-05
-
2022-01-23
Survey response — 3 months, dose 3MedDRA: Exposure to SARS-CoV-2, Eye disorder, Headache, Pyrexia, Visual impairment, Vitreous detachment — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Detached vitreous in RT eye · Healthcare visit (other): Overall health is good, but eye issue remains. COVID exposure last week symptoms of headache mild fever resolved after 2 days. Today, 1/23/22 am good aside from visual issues assume due to vitreous detachment in eye.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-23
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-01-24
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-04-03
Dose 4 — Moderna
- 2022-04-24
- 2022-05-18
- 2022-07-03
- 2022-10-02
- 2023-04-05
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-28 | Moderna | |
| 2 | 2021-01-25 | Moderna | |
| 3 | 2021-10-24 | Moderna | No |
| 4 | 2022-04-03 | Moderna | No |
Call center
3 call center cases
1 successful · 2 unsuccessful
Free text
Release 2 — days 1–6 daily, dose 2
Systemic reaction (other): Just soreness in upper arm muscle injection site, nothing unusual after a vaccine
Release 3 — day 14, dose 2
Symptoms: Osteoarthritis flare up in fingers, doubtful is related to the vaccine
Release 9 — 6 months, dose 2
Symptoms: Intermittent noticing taste is off sometimes, not sure if related to vaccine at all, and it's not consistent
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): New floater in right vision field
Healthcare visit (other): Going to eye Dr. to have eye checked, make sure no serious issue with new visual floater
Systemic reaction (other): Unrelated most probably, but have developed a spontaneous ocular vitruous tear with retinal detachment since receiving my booster vaccine.e
Healthcare visit (other): Opthalmologist in office visit, after which a retina surgical visit appointmen now is scheduled.t
Release 11 — 3 months, dose 3
Symptoms: Detached vitreous in RT eye
Healthcare visit (other): Overall health is good, but eye issue remains. COVID exposure last week symptoms of headache mild fever resolved after 2 days. Today, 1/23/22 am good aside from visual issues assume due to vitreous detachment in eye.
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 |
|---|---|---|---|---|
| HCVO | Exposure to SARS-CoV-2 | · | · | ✓ |
| HCVO | Eye disorder | · | · | ✓ |
| HCVO | Headache | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| HCVO | Pyrexia | · | · | ✓ |
| HCVO | Visual impairment | · | · | ✓ |
| HCVO | Vitreous detachment | · | · | ✓ |
| HCVO | Vitreous floaters | · | · | ✓ |
| SD | Osteoarthritis | ✓ | ✓ | ✓ |
| SD | Taste disorder | ✓ | · | ✓ |
| SD | Vitreous detachment | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Retinal detachment | · | · | ✓ |
| SRO | Vitreous floaters | · | · | ✓ |
| SRO | Vitreous injury | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release