5UB-18214-64605
2 vaccinations
3 coded responses
14 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 941 / CA
- Registered
- 2020-12-27
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-23
Dose 1 — Moderna
-
2020-12-27
Registered in v-safe
- 2020-12-27
-
2020-12-28
Survey response — days 1–6 daily, dose 1MedDRA: Chills, Erythema, Fatigue, Headache, Influenza like illness, Injected limb mobility decreased, Injection site pain, Pain, Skin warm — Feeling: Good · HeadacheFree text: I want to report that I got my vaccine on Wednesday, December 23. What I'm not about to capture here because I didn't sign up for this until multiple days after vaccine is that fit 36 hours post vaccine, my deltoid muscle was hot and the skin was red. I could barely lift my arm and pain was 7/10. I had severe fatigue, chills, headache, I felt febrile although the wasn't running a fever, and I felt flu-like with all over achiness. The peak of this was about 16-28 hours post vaccine. Within 36 hours I felt back to normal with just mild tenderness at injection site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2020-12-29
- 2021-01-06
- 2021-01-13
-
2021-01-20
Dose 2 — Moderna
-
2021-01-27
Health check-in — day 7, dose 2Feeling: Good · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-04-21
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2021-07-21
Survey response — 6 months, dose 2MedDRA: Headache, Pre-existing disease, Sneezing — Feeling: FairFree text: Headaches, sneezing, likely my usual seasonal allergies.MedDRA releases: 2024-11 · check-in free text available
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2022-01-20
Survey response — 12 months, dose 2MedDRA: Cervical radiculopathy, Neck pain, Pain in extremity — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Neck/arm pain due to cervical radiculopathyMedDRA releases: 2024-11 · check-in free text available
-
2022-01-20
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-01-21
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-23 | Moderna | |
| 2 | 2021-01-20 | Moderna |
Call center
1 call center case
1 unsuccessful
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): I want to report that I got my vaccine on Wednesday, December 23. What I'm not about to capture here because I didn't sign up for this until multiple days after vaccine is that fit 36 hours post vaccine, my deltoid muscle was hot and the skin was red. I could barely lift my arm and pain was 7/10. I had severe fatigue, chills, headache, I felt febrile although the wasn't running a fever, and I felt flu-like with all over achiness. The peak of this was about 16-28 hours post vaccine. Within 36 hours I felt back to normal with just mild tenderness at injection site.
Release 9 — 6 months, dose 2
Symptoms: Headaches, sneezing, likely my usual seasonal allergies.
Release 10 — 12 months, dose 2
Symptoms: Neck/arm pain due to cervical radiculopathy
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 | Cervical radiculopathy | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Neck pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Influenza like illness | ✓ | ✓ | ✓ |
| SRO | Injected limb mobility decreased | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Joint range of motion decreased | ○ | ○ | ○ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ○ | ○ | ○ |
| SRO | Skin warm | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release