64N-31482-18333
4 vaccinations
5 coded responses
21 check-ins
4 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 109 / NY
- Registered
- 2021-04-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-15
Dose 1 — Moderna
-
2021-04-12
Dose 2 — Moderna
-
2021-04-16
Registered in v-safe
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2021-04-16
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness, Unevaluable event — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): Short sudden dizzy spell · Healthcare visit (other): Phone and email and virtual for tomorrowMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-16
Report sent to call center — days 1–6 daily, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-04-17
Survey response — days 1–6 daily, dose 2MedDRA: Chills, Headache, Pain, Pyrexia — Feeling: GoodFree text: I had most symptoms day after shot, chills, fever, aches, headacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-18
- 2021-04-19
- 2021-04-26
- 2021-05-03
- 2021-05-10
- 2021-05-17
- 2021-05-24
-
2021-07-12
Survey response — 3 months, dose 2MedDRA: Gastrointestinal pain, Malaise — Feeling: Good · Be unable to do your normal daily activitiesFree text: Couple weeks ago I had intestinal pain bowel movement, after dinner Frida and not feeling well on Monday better next day. But it may have been something I ate out at an outdoor event on Thursday because my husband had some Gastro pains also.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-10-11
-
2021-12-02
Dose 3 — Moderna
-
2022-04-01
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-04-12
-
2022-04-24
Dose 4 — Moderna
- 2022-05-01
- 2022-05-08
- 2022-05-15
- 2022-05-22
- 2022-05-29
- 2022-06-05
- 2022-07-24
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2022-10-23
Survey response — 6 months, dose 4MedDRA: Office visit, Urinary tract disorder — 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 professionalFree text: Symptoms: Symptoms similar to a UTI or kidney stone however I have neither still doing more testing. It's been for one month now. I'm feeling much better but still not normal. · Healthcare visit (other): Urologist visit & CT scanMedDRA releases: 2024-11 · check-in free text available
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2022-10-23
Report sent to call center — 6 months, dose 4Be 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)
-
2022-10-25
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-04-24
Survey response — 12 months, dose 4MedDRA: Bladder cancer — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-04-24
Report sent to call center — 12 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-04-25
-
2023-04-25
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-15 | Moderna | |
| 2 | 2021-04-12 | Moderna | |
| 3 | 2021-12-02 | Moderna | No |
| 4 | 2022-04-24 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Short sudden dizzy spell
Healthcare visit (other): Phone and email and virtual for tomorrow
Systemic reaction (other): I had most symptoms day after shot, chills, fever, aches, headache
Release 9 — 3 months, dose 2
Symptoms: Couple weeks ago I had intestinal pain bowel movement, after dinner Frida and not feeling well on Monday better next day. But it may have been something I ate out at an outdoor event on Thursday because my husband had some Gastro pains also.
Release 12 — 6 months, dose 4
Symptoms: Symptoms similar to a UTI or kidney stone however I have neither still doing more testing. It's been for one month now. I'm feeling much better but still not normal.
Healthcare visit (other): Urologist visit & CT scan
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 | Bladder cancer | · | · | ✓ |
| SD | Diarrhoea | ○ | ○ | ○ |
| SD | Gastrointestinal pain | ✓ | ✓ | ✓ |
| SD | Malaise | ✓ | ✓ | ✓ |
| SD | Urinary tract disorder | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release