5UM-27247-89023
3 vaccinations
5 coded responses
28 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 21-25
- ZIP prefix
- 752 / TX
- Registered
- 2020-12-25
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-23
Dose 1 — Moderna
-
2020-12-25
Registered in v-safe
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2020-12-25
Survey response — days 1–6 daily, dose 1MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, NauseaFree text: I have asthmaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2020-12-26
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Fatigue or tiredness, NauseaAdult check-in
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2020-12-27
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
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2020-12-28
Survey response — days 1–6 daily, dose 1MedDRA: Asthma, Endometriosis — Feeling: Fair · Headache, Fatigue or tiredness, Nausea, Abdominal painFree text: Endometriosis and asthmaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2020-12-29
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Fever · Chills, Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2020-12-30
- 2021-01-06
- 2021-01-13
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2021-01-20
Survey response — day 28, dose 1MedDRA: Headache, Nausea, Oropharyngeal pain — Feeling: FairFree text: Headaches, nausea, sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-25
Dose 2 — Moderna
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2021-01-26
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-01-27
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
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2021-01-28
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling, Itching · NauseaAdult check-in
- 2021-01-29
- 2021-01-30
- 2021-02-01
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2021-02-08
Survey response — day 14, dose 2MedDRA: Headache — Feeling: FairFree text: Lingering headacheMedDRA 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
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2021-07-26
Survey response — 6 months, dose 2MedDRA: Asthma, Hospitalisation, Pre-existing disease, Respiratory distress, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Asthma attack. Respiratory distress. Hospitalized for Asthma. Got COVID test. All rest were negative. My antibodies read 2,110. The reference range was<1.00MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-07-26
Report sent to call center — 6 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 pr1 call case(s)
- 2021-08-04
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2021-08-05
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
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2021-12-20
Dose 3 — Moderna
- 2022-01-25
- 2022-01-25
- 2022-01-31
- 2022-03-21
- 2022-06-20
- 2022-12-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-23 | Moderna | |
| 2 | 2021-01-25 | Moderna | |
| 3 | 2021-12-20 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-07-26 | Successful 2021-08-05 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): I have asthma
Systemic reaction (other): Endometriosis and asthma
Release 2 — day 28, dose 1
Symptoms: Headaches, nausea, sore throat
Release 3 — day 14, dose 2
Symptoms: Lingering headache
Release 9 — 6 months, dose 2
Symptoms: Asthma attack. Respiratory distress. Hospitalized for Asthma. Got COVID test. All rest were negative. My antibodies read 2,110. The reference range was<1.00
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 | Asthma | ✓ | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | · | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | · | ✓ |
| SD | Respiratory distress | ✓ | · | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | · | ✓ |
| SRO | Asthma | ✓ | ✓ | ✓ |
| SRO | Endometriosis | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ○ | ○ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release