5V9-17455-84392
2 vaccinations
6 coded responses
12 check-ins
6 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 502 / IA
- Registered
- 2021-02-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-14
Dose 1 — Moderna
-
2021-02-17
Registered in v-safe
-
2021-02-17
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia, Chills, Headache, Pain — Feeling: Good · Site: Pain · Be unable to do your normal daily activitiesFree text: Chills, Headache, joint pain and body aches on first evening/night after I received vaccine on 2/14MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-23
- 2021-03-09
- 2021-03-15
-
2021-03-17
Dose 2 — Moderna
-
2021-03-23
Survey response — days 1–6 daily, dose 2MedDRA: Chills, Headache, Pain, Pyrexia — Feeling: Fair · Be unable to workFree text: 18 hours after 2nd vaccine I experienced 101 fever, chills, headache and body achesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-09
- 2021-04-16
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2021-04-23
Survey response — day 35, dose 2MedDRA: Ageusia, Anosmia, Urinary tract infection — Feeling: Fair · Be unable to work, Be unable to do your normal daily activitiesFree text: Diagnosed with UTI and CT revealed Acute Diverticulitis so under doctors care now. I still do not have my taste and smell back from having Covid in 12/2020.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-28
Survey response — day 42, dose 2MedDRA: Ageusia, Anosmia, Diverticulitis, Unevaluable event — Feeling: Good · Be unable to work, 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: Symptoms: Continued minimal taste and no smell since diagnosed with Covid 12/1/2020. Newly diagnosed with Acute Diverticulitis · Healthcare visit (other): CT scanMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-28
Report sent to call center — day 42, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-06-18
Survey response — 3 months, dose 2MedDRA: Ageusia, Anosmia — Feeling: GoodFree text: Continued loss of smell and some decreased taste since I was diagnosed with Covid-19 on 12/1/2020.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-09-15
Survey response — 6 months, dose 2MedDRA: Meniscus injury, Office visit — 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 · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Complex medial meniscus tear having Surgery tomorrow, 9/16 · Healthcare visit (other): DMOSMedDRA releases: 2024-11 · check-in free text available
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2021-09-15
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)
-
2021-09-19
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-03-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-14 | Moderna | |
| 2 | 2021-03-17 | Moderna |
Call center
2 call center cases
2 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Chills, Headache, joint pain and body aches on first evening/night after I received vaccine on 2/14
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): 18 hours after 2nd vaccine I experienced 101 fever, chills, headache and body aches
Release 7 — day 35, dose 2
Symptoms: Diagnosed with UTI and CT revealed Acute Diverticulitis so under doctors care now. I still do not have my taste and smell back from having Covid in 12/2020.
Release 8 — day 42, dose 2
Symptoms: Continued minimal taste and no smell since diagnosed with Covid 12/1/2020. Newly diagnosed with Acute Diverticulitis
Healthcare visit (other): CT scan
Release 9 — 3 months, dose 2
Symptoms: Continued loss of smell and some decreased taste since I was diagnosed with Covid-19 on 12/1/2020.
Release 9 — 6 months, dose 2
Symptoms: Complex medial meniscus tear having Surgery tomorrow, 9/16
Healthcare visit (other): DMOS
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 | Office visit | · | · | ✓ |
| HCVO | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Ageusia | ✓ | ✓ | ✓ |
| SD | Anosmia | ✓ | ✓ | ✓ |
| SD | Diverticulitis | ✓ | ✓ | ✓ |
| SD | Meniscus injury | · | · | ✓ |
| SD | Urinary tract infection | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release