682-33546-42566
4 vaccinations
4 coded responses
38 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 829 / WY
- Registered
- 2021-01-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-11
Registered in v-safe
-
2021-01-11
Dose 1 — Moderna
- 2021-01-11
- 2021-01-12
- 2021-01-13
- 2021-01-14
- 2021-01-15
-
2021-01-16
Survey response — days 1–6 daily, dose 1MedDRA: Aphthous ulcer — Feeling: GoodFree text: I did have two canker sores appear in my inner lip Thursday night, but they have been healing since then.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-17
- 2021-01-18
- 2021-01-25
- 2021-02-01
-
2021-02-08
Dose 2 — Moderna
-
2021-02-15
Survey response — day 7, dose 2MedDRA: Chills, Pyrexia — Feeling: Good · Site: Pain, Redness, Swelling · Be unable to workFree text: The day after my shot, so on February 9th, I had a fever of 101.6, chills and other symptomsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-22
- 2021-03-01
- 2021-03-08
- 2021-03-15
- 2021-03-22
- 2021-05-10
- 2021-08-09
-
2021-10-29
Dose 3 — Moderna
- 2021-10-29
-
2021-10-30
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-10-31
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
-
2021-11-19
Survey response — day 21, dose 3MedDRA: Asthma, Pre-existing disease — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: My asthma got worse Monday and I had to get extra medicine.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-19
Report sent to call center — day 21, dose 3Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-11-24
- 2021-11-26
- 2021-12-01
-
2021-12-01
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-12-05
Survey response — day 35, dose 3MedDRA: Nasopharyngitis — Feeling: Poor · Be unable to do your normal daily activitiesFree text: I have a cold. Why do you ask? You guys call me when I miss work and then tell me you don't need a report if I don't think it was caused by the vaccine. How do I know??MedDRA releases: 2024-11 · check-in free text available
- 2021-12-10
- 2022-01-28
-
2022-04-15
Dose 4 — Moderna
- 2022-04-15
- 2022-04-16
- 2022-04-17
- 2022-04-18
- 2022-04-19
- 2022-04-20
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-08 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): I did have two canker sores appear in my inner lip Thursday night, but they have been healing since then.
Release 4 — day 7, dose 2
Systemic reaction (other): The day after my shot, so on February 9th, I had a fever of 101.6, chills and other symptoms
Release 10 — day 21, dose 3
Symptoms: My asthma got worse Monday and I had to get extra medicine.
Release 10 — day 35, dose 3
Symptoms: I have a cold. Why do you ask? You guys call me when I miss work and then tell me you don't need a report if I don't think it was caused by the vaccine. How do I know??
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 | Nasopharyngitis | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Aphthous ulcer | ✓ | ✓ | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release