5UA-47027-13339
6 vaccinations
11 coded responses
36 check-ins
10 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 601 / IL
- Registered
- 2021-02-10
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-10
Registered in v-safe
-
2021-02-10
Dose 1 — Moderna
-
2021-02-10
Survey response — day 0, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-11
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: Good · Site: Pain · DiarrheaFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-12
-
2021-02-13
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-14
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-15
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-16
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event, Unevaluable event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-17
Survey response — day 7, dose 1MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-24
- 2021-03-03
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2021-03-12
Survey response — day 28, dose 1MedDRA: Haemoglobin decreased, Hospitalisation, Transfusion — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: On 3/9/21 my Hemoglobin Test was 5.8. I was admitted in the hospital unti 3/11/21 until the test showed 7.2. I was given 2 Transfusions & I will get my 2nd Shot on Saturday 3/13/21 @11:30AMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-12
Report sent to call center — day 28, dose 1Get care from a doctor or other healthcare professional1 call case(s)
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2021-03-13
Dose 2 — Moderna
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2021-03-17
Survey response — days 1–6 daily, dose 2MedDRA: No adverse event — Feeling: GoodFree text: No Reactions @ allMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-27
- 2021-04-03
- 2021-04-10
- 2021-04-17
- 2021-04-24
- 2021-06-12
-
2021-08-18
Dose 3 — Moderna
- 2021-09-11
- 2021-10-13
- 2021-11-17
- 2022-02-16
-
2022-04-05
Dose 4 — Moderna
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2022-08-18
Survey response — 12 months, dose 3MedDRA: Emergency care, Faeces discoloured, Haemoglobin decreased, Internal haemorrhage, Polyp, Pre-existing disease — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Hemoglobin was very low in March 2022 I went to the ER. My stool was black, the Dr's did an endoscopy & colonoscopy & couldn't find the internal bleeding. I'm scheduled for a colonoscopy on Mon 3/22 to take out 2 polyps. I have Luekemia CMLMedDRA releases: 2024-11 · check-in free text available
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2022-08-18
Report sent to call center — 12 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-08-19
- 2022-08-19
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2022-09-07
Dose 5 — ModernaCo-administered: Flu
- 2022-10-04
- 2022-10-13
- 2022-10-19
- 2022-12-07
- 2023-03-08
-
2023-04-30
Dose 6 — Moderna
- 2023-05-08
- 2023-05-14
- 2023-05-21
- 2023-05-28
- 2023-06-04
- 2023-06-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-10 | Moderna | |
| 2 | 2021-03-13 | Moderna | |
| 3 | 2021-08-18 | Moderna | No |
| 4 | 2022-04-05 | Moderna | No |
| 5 | 2022-09-07 | Moderna | Flu |
| 6 | 2023-04-30 | Moderna | No |
Call center
2 call center cases
2 unsuccessful
1 wait over 3 months for a first call
Free text
Release 4 — day 0, dose 1
Systemic reaction (other): No
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): No
Systemic reaction (other): No
Systemic reaction (other): No
Systemic reaction (other): No
Systemic reaction (other): No
Release 4 — day 7, dose 1
Systemic reaction (other): No
Release 5 — day 28, dose 1
Symptoms: On 3/9/21 my Hemoglobin Test was 5.8. I was admitted in the hospital unti 3/11/21 until the test showed 7.2. I was given 2 Transfusions & I will get my 2nd Shot on Saturday 3/13/21 @11:30A
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): No Reactions @ all
Release 12 — 12 months, dose 3
Symptoms: Hemoglobin was very low in March 2022 I went to the ER. My stool was black, the Dr's did an endoscopy & colonoscopy & couldn't find the internal bleeding. I'm scheduled for a colonoscopy on Mon 3/22 to take out 2 polyps. I have Luekemia CML
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 | Emergency care | · | · | ✓ |
| SD | Faeces discoloured | · | · | ✓ |
| SD | Haemoglobin decreased | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Internal haemorrhage | · | · | ✓ |
| SD | Polyp | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Transfusion | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ○ | ✓ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release