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5ZK-11905-38974

4 vaccinations 5 coded responses 41 check-ins 5 free-text entries 0 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
610 / IL
Registered
2021-02-03
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-03
    Registered in v-safe
  2. 2021-02-03
    Dose 1 — Moderna
  3. 2021-02-03
    Health check-in — day 0, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  4. 2021-02-04
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  5. 2021-02-05
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-02-06
    Survey response — days 1–6 daily, dose 1
    MedDRA: Feeling abnormal — Feeling: Fair · Fever · Headache, Fatigue or tiredness
    Free text: Vision a little fuzzy, similar to when started Amlodipine Bensalate 5mg Aug 6, 2020, eventually passed
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-02-07
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Headache
    Adult check-in
  8. 2021-02-08
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-02-09
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-02-11
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-02-17
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-02-24
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-03-03
    Dose 2 — Moderna
  14. 2021-03-03
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-03-04
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain, Redness · Chills, Fatigue or tiredness
    Adult check-in
  16. 2021-03-05
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · None
    Adult check-in
  17. 2021-03-06
    Survey response — days 1–6 daily, dose 2
    MedDRA: Erythema, Pruritus — Feeling: Good · Site: Itching
    Free text: Sensitive to latex, nurse used latex bandaid, residual redness & itching from
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-03-07
    Survey response — days 1–6 daily, dose 2
    MedDRA: Pruritus, Rash — Feeling: Good · Rash, not including the immediate area around the injection site
    Free text: Underside of arm, below elbow, slight rash, itchy
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-03-08
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-03-09
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-03-10
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  22. 2021-03-17
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-03-24
    Survey response — day 21, dose 2
    MedDRA: Eye disorder — Feeling: Fair
    Free text: My eyes felt like they crossed ( mini electrical short- circuit?) Last night at 7:33pm, when was returning to co.puter to read an email. I called for husband in normal voice, but he had gone downstairs. Lasted 1-3 min, ok after. Debated on ER toda
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  24. 2021-03-31
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-04-07
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-04-14
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-06-02
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-09-01
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  29. 2021-11-30
    Dose 3 — Moderna
  30. 2022-03-03
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in
  31. 2022-10-05
    Dose 4 — Moderna
  32. 2022-10-05
    Health check-in — day 0, dose 4
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  33. 2022-10-06
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Site: Pain · Chills, Fatigue or tiredness
    Adult check-in
  34. 2022-10-07
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Site: Pain · None
    Adult check-in
  35. 2022-10-08
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  36. 2022-10-09
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  37. 2022-10-10
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  38. 2022-10-11
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  39. 2022-10-12
    Health check-in — day 7, dose 4
    Feeling: Good · None
    Adult check-in
  40. 2022-10-19
    Survey response — day 14, dose 4
    MedDRA: Fatigue — Feeling: Good
    Free text: Tired
    MedDRA releases: 2024-11 · check-in free text available
  41. 2022-10-26
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  42. 2022-11-02
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  43. 2022-11-09
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  44. 2022-11-16
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  45. 2023-01-04
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in
  46. 2023-04-05
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-02-03Moderna
22021-03-03Moderna
32021-11-30Moderna No
42022-10-05Moderna No

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-06

Systemic reaction (other): Vision a little fuzzy, similar to when started Amlodipine Bensalate 5mg Aug 6, 2020, eventually passed

Release 5 — days 1–6 daily, dose 2

2021-03-06

Systemic reaction (other): Sensitive to latex, nurse used latex bandaid, residual redness & itching from

2021-03-07

Systemic reaction (other): Underside of arm, below elbow, slight rash, itchy

Release 6 — day 21, dose 2

2021-03-24

Symptoms: My eyes felt like they crossed ( mini electrical short- circuit?) Last night at 7:33pm, when was returning to co.puter to read an email. I called for husband in normal voice, but he had gone downstairs. Lasted 1-3 min, ok after. Debated on ER toda cut off by CDC

Release 12 — day 14, dose 4

2022-10-19

Symptoms: Tired

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

FieldPreferred term2021-092023-042024-11
SDEye disorder ✓ ✓ ✓
SDFatigue · · ✓
SROErythema ✓ ✓ ✓
SROFeeling abnormal ✓ ✓ ✓
SROPruritus ✓ ✓ ✓
SRORash ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release

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