69Z-12556-64111
4 vaccinations
2 coded responses
36 check-ins
2 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 160 / PA
- Registered
- 2021-02-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
M2E-17199-44211
Child or adolescent in my care · Female · 2022-07-04
Timeline
-
2021-02-13
Registered in v-safe
-
2021-02-13
Dose 1 — Moderna
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-27
- 2021-03-06
-
2021-03-13
Dose 2 — Moderna
- 2021-03-13
-
2021-03-14
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-15
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-16
-
2021-03-17
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection siteAdult check-in
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-27
- 2021-04-03
- 2021-04-10
- 2021-04-17
- 2021-04-24
- 2021-06-12
- 2021-09-11
-
2021-11-19
Dose 3 — Moderna
- 2022-03-13
-
2022-07-08
Dose 4 — Moderna
-
2022-07-09
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-07-10
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-07-11
-
2022-07-12
Survey response — days 1–6 daily, dose 4MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Positive covid testMedDRA releases: 2024-11 · check-in free text available
-
2022-07-12
Report sent to call center — days 1–6 daily, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-07-13
Survey response — days 1–6 daily, dose 4MedDRA: SARS-CoV-2 test positive — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Positive covid testMedDRA releases: 2024-11 · check-in free text available
- 2022-07-14
- 2022-07-25
- 2022-07-31
- 2022-08-07
- 2022-08-12
- 2023-01-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-13 | Moderna | |
| 2 | 2021-03-13 | Moderna | |
| 3 | 2021-11-19 | Moderna | No |
| 4 | 2022-07-08 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-07-12 | Unsuccessful |
Free text
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Positive covid test
Systemic reaction (other): Positive covid test
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 |
|---|---|---|---|---|
| SRO | SARS-CoV-2 test positive | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release