5YT-28051-10514
2 vaccinations
6 coded responses
20 check-ins
6 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 826 / WY
- Registered
- 2021-03-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-04
Registered in v-safe
-
2021-03-04
Dose 1 — Moderna
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2021-03-04
Survey response — day 0, dose 1MedDRA: Fatigue, Headache — Feeling: Good · Headache, Fatigue or tirednessFree text: Headache and fatigue were mildMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-05
Health check-in — days 1–6 daily, dose 1Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-03-06
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2021-03-07
Survey response — days 1–6 daily, dose 1MedDRA: Upper-airway cough syndrome — Feeling: Good · Fatigue or tirednessFree text: Nose drip periodically the last 3 daysMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-08
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2021-04-01
Dose 2 — Moderna
- 2021-04-01
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2021-04-02
Survey response — days 1–6 daily, dose 2MedDRA: Vision blurred — Feeling: Poor · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: My right eye had blurred vision for about 6 hoursMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-03
- 2021-04-04
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2021-04-05
Survey response — days 1–6 daily, dose 2MedDRA: Rash macular — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Red blotch on left side of stomach might be insect bite not sure yetMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-06
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2021-04-07
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-04-08
Health check-in — day 7, dose 2Feeling: Fair · Joint pains, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-04-15
Survey response — day 14, dose 2MedDRA: Office visit, Skin mass, Tenderness — Feeling: GoodFree text: A under skin nodule on lower right leg that is tender, seen doctor will do ultra sound next week if it doesn't recedeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-22
- 2021-04-29
- 2021-05-06
- 2021-07-01
- 2021-09-30
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2022-04-01
Survey response — 12 months, dose 2MedDRA: Arthritis, Asthenia, Dysmenorrhoea, Malaise, Pre-existing disease — Feeling: GoodFree text: Menstrual like cramps ...not as much energy...arthritis seems more advanced...1st two shots ok. Booster i got sick from and just not as energetic as i was prior to itMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-04 | Moderna | |
| 2 | 2021-04-01 | Moderna |
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): Headache and fatigue were mild
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Nose drip periodically the last 3 days
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): My right eye had blurred vision for about 6 hours
Systemic reaction (other): Red blotch on left side of stomach might be insect bite not sure yet
Release 7 — day 14, dose 2
Symptoms: A under skin nodule on lower right leg that is tender, seen doctor will do ultra sound next week if it doesn't recede
Release 11 — 12 months, dose 2
Symptoms: Menstrual like cramps ...not as much energy...arthritis seems more advanced...1st two shots ok. Booster i got sick from and just not as energetic as i was prior to it
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 | Arthritis | · | · | ✓ |
| SD | Asthenia | · | · | ✓ |
| SD | Dysmenorrhoea | · | · | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Skin mass | ✓ | ✓ | ✓ |
| SD | Tenderness | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Rash macular | ✓ | ✓ | ✓ |
| SRO | Upper-airway cough syndrome | ✓ | ✓ | ✓ |
| SRO | Vision blurred | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release