6DA-22794-36942
4 vaccinations
3 coded responses
34 check-ins
2 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 837 / ID
- Registered
- 2021-02-06
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-06
Registered in v-safe
-
2021-02-06
Dose 1 — Moderna
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-12
- 2021-02-13
- 2021-02-20
- 2021-02-27
-
2021-03-06
Dose 2 — Moderna
- 2021-03-06
- 2021-03-07
-
2021-03-08
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-20
- 2021-03-27
- 2021-04-03
- 2021-04-10
- 2021-04-17
- 2021-06-05
-
2021-09-04
Survey response — 6 months, dose 2MedDRA: Cardiac disorder, Emergency care, Heart rate increased, Office visit, Pneumonia, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: I have p sumo is and a heart problem but I do not think they are at all related to the vaccine · Healthcare visit (other): I had my yearly Medicare review and my heart rate was 159. My Dr. Sent me to the ER. I was there for 8 hrs. They got my heart rate down with meds and discovered I had pneumonia. None of this related to vaccine. I am looking forward to the boosteMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-09-04
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-27
- 2021-09-30
-
2021-09-30
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-10-28
Dose 3 — Moderna
-
2022-03-06
Survey response — 12 months, dose 2MedDRA: Colitis ischaemic, Hospitalisation — Feeling: Poor · Get care from a doctor or other healthcare professional · HospitalizationFree text: I have Ischemic Colitis. I just got home from a week in the hospital.MedDRA releases: 2024-11 · check-in free text available
-
2022-03-06
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
-
2022-03-08
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-04-08
Dose 4 — Moderna
- 2022-04-26
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-07-08
- 2022-10-07
-
2023-04-08
Survey response — 12 months, dose 4MedDRA: Hospitalisation, Spinal operation — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationMedDRA releases: 2024-11
-
2023-04-08
Report sent to call center — 12 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
-
2023-04-11
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 | 2021-02-06 | Moderna | |
| 2 | 2021-03-06 | Moderna | |
| 3 | 2021-10-28 | Moderna | No |
| 4 | 2022-04-08 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 9 — 6 months, dose 2
Symptoms: I have p sumo is and a heart problem but I do not think they are at all related to the vaccine
Healthcare visit (other): I had my yearly Medicare review and my heart rate was 159. My Dr. Sent me to the ER. I was there for 8 hrs. They got my heart rate down with meds and discovered I had pneumonia. None of this related to vaccine. I am looking forward to the booste cut off by CDC
Release 11 — 12 months, dose 2
Symptoms: I have Ischemic Colitis. I just got home from a week in the hospital.
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 | Emergency care | ✓ | · | ✓ |
| HCVO | Heart rate increased | ✓ | · | ✓ |
| HCVO | Office visit | ✓ | · | ✓ |
| HCVO | Pneumonia | ✓ | · | ✓ |
| SD | Cardiac disorder | ✓ | · | ✓ |
| SD | Colitis ischaemic | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Spinal operation | · | · | ✓ |
| SD | Unevaluable event | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release