6EH-21389-95930
2 vaccinations
5 coded responses
24 check-ins
5 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 070 / NJ
- Registered
- 2021-01-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-18
Registered in v-safe
-
2021-01-18
Dose 1 — Moderna
- 2021-01-18
-
2021-01-19
Survey response — days 1–6 daily, dose 1MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache · Be unable to workFree text: A little DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-02-01
- 2021-02-08
-
2021-02-15
Dose 2 — Moderna
- 2021-02-15
-
2021-02-16
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-02-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection siteAdult check-in
-
2021-02-18
Survey response — days 1–6 daily, dose 2MedDRA: Lip swelling, Medical counselling, Self-medication, Swelling face, Urticaria — Feeling: Fair · Site: Redness, Swelling, Itching · Headache, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: My left upperlip and face swelled around 3:30 this morning. I called the Dr. he said take Benadryl. It has reduced a bit but not all the way. My hives are huge on my back and the back of my neck.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-18
Report sent to call center — days 1–6 daily, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-02-19
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Swelling, Itching · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-02-20
Health check-in — days 1–6 daily, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2021-02-21
- 2021-02-22
- 2021-03-01
- 2021-03-09
-
2021-03-15
Survey response — day 28, dose 2MedDRA: Pain in extremity, Rash — Feeling: GoodFree text: I have had small blemishes on my face and the back of my ear. My upper arm experiences random achyness from time to time.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-22
- 2021-03-29
- 2021-05-17
- 2021-08-09
-
2021-08-16
Survey response — 6 months, dose 2MedDRA: Atrial fibrillation — Feeling: Fair · Get care from a doctor or other healthcare professional · HospitalizationFree text: Afib due possibly to exposure to alkyl dimethyl benzyl ammonium chloride. Having tests to see.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-16
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-20
-
2022-02-16
Survey response — 12 months, dose 2MedDRA: Office visit, Tendonitis, Vitreous floaters — Feeling: Fair · 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: White thing appears briefly in my right eye from time to time, Dr visit upcoming for that. I have shoulder tendonitis. I just saw the dr and got a shot of cortisone. · Healthcare visit (other): Dr visit in the dr officeMedDRA releases: 2024-11 · check-in free text available
-
2022-02-16
Report sent to call center — 12 months, dose 2Be 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)
-
2022-02-17
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-18 | Moderna | |
| 2 | 2021-02-15 | Moderna |
Call center
3 call center cases
3 successful
1 wait over 3 months for a first call
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): A little Dizziness
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): My left upperlip and face swelled around 3:30 this morning. I called the Dr. he said take Benadryl. It has reduced a bit but not all the way. My hives are huge on my back and the back of my neck.
Release 5 — day 28, dose 2
Symptoms: I have had small blemishes on my face and the back of my ear. My upper arm experiences random achyness from time to time.
Release 9 — 6 months, dose 2
Symptoms: Afib due possibly to exposure to alkyl dimethyl benzyl ammonium chloride. Having tests to see.
Release 11 — 12 months, dose 2
Symptoms: White thing appears briefly in my right eye from time to time, Dr visit upcoming for that. I have shoulder tendonitis. I just saw the dr and got a shot of cortisone.
Healthcare visit (other): Dr visit in the dr office
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 | · | · | ✓ |
| SD | Atrial fibrillation | ✓ | · | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Tendonitis | · | · | ✓ |
| SD | Vitreous floaters | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Lip swelling | ✓ | ✓ | ✓ |
| SRO | Medical counselling | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Swelling face | ✓ | ✓ | ✓ |
| SRO | Urticaria | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release