6JV-96787-62096
1 vaccination
7 coded responses
9 check-ins
8 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 26-30
- ZIP prefix
- 592 / MT
- Registered
- 2021-11-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-11-18
Registered in v-safe
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2021-11-18
Dose 1 — Moderna
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2021-11-18
Survey response — day 0, dose 1MedDRA: Back pain, Breast pain, Skin burning sensation — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Back pain, breast pain, my skin feels like its on fire.MedDRA releases: 2024-11 · check-in free text available
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2021-11-19
Survey response — days 1–6 daily, dose 1MedDRA: Breast pain, Burning sensation, Chest pain, Dyspnoea, Vision blurred — Feeling: Poor · Site: Pain, Redness, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Blurry vision, chest pain, my lungs feel like their are on fire, shortness of breath., my breast closest to my injection hurts so bad.MedDRA releases: 2024-11 · check-in free text available
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2021-11-20
Survey response — days 1–6 daily, dose 1MedDRA: Breast pain, Burning sensation, Chest pain, Dyspnoea exertional, Lymphadenopathy, Pruritus, Respiratory disorder, Skin burning sensation, Swelling of eyelid, Vision blurred — Feeling: Poor · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: Chest pain, shortness of breath with activity, my lungs feel like they are on fire with inspiration, my skin feels like its on fire, swollen eyelids, blurry vision, swollen lymph nodes on my entire right side, right side breast pain with itchy nippleMedDRA releases: 2024-11 · check-in free text available
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2021-11-22
Survey response — days 1–6 daily, dose 1MedDRA: Brain fog, Chest pain, Dyspnoea exertional, Painful respiration, Pulmonary pain, Skin burning sensation, Vision blurred — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: Brain fog, blurry vision, chest pain, lung pain with inspiration, extreem shortness of breath with activity, my skin feels like its on fire.MedDRA releases: 2024-11 · check-in free text available
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2021-11-23
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activitiesFree text: Brain fog, extreme shortness of breath with activity, mixing up words, blurry vision, swollen eyelids. Chest apin and burning on inspirationAdult check-in · check-in free text available
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2021-11-27
Survey response — day 7, dose 1MedDRA: Brain fog, Disorganised speech, Dyspnoea exertional — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: Brain fog, mixing up words, shortness if breath with activityMedDRA releases: 2024-11 · check-in free text available
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2021-12-27
Survey response — day 35, dose 1MedDRA: Alopecia, Aphasia, Brain fog, Dyspnoea exertional, Heart rate increased, Menstruation irregular — Feeling: FairFree text: I havent gotten a period. Still short of breath with any activity. My resting pulse is 15 higher than prior to vaccination. Hair is falling out. Brain fog. I'm mixing up words and lettersMedDRA releases: 2024-11 · check-in free text available
- 2022-02-19
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2022-11-18
Survey response — 12 months, dose 1MedDRA: Chest pain, Dyspnoea, Heart rate increased — Feeling: Fair · Be unable to do your normal daily activitiesFree text: I am short of breath with chest pain any time i exert myself. Anytime my heat rate goes about 100. (My resting HR used to be 50 is now high 60s to 70s even 80s occasionally.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-11-18 | Moderna | No |
Free text
Release 10 — day 0, dose 1
Systemic reaction (other): Back pain, breast pain, my skin feels like its on fire.
Release 10 — days 1–6 daily, dose 1
Systemic reaction (other): Blurry vision, chest pain, my lungs feel like their are on fire, shortness of breath., my breast closest to my injection hurts so bad.
Systemic reaction (other): Chest pain, shortness of breath with activity, my lungs feel like they are on fire with inspiration, my skin feels like its on fire, swollen eyelids, blurry vision, swollen lymph nodes on my entire right side, right side breast pain with itchy nipple cut off by CDC
Systemic reaction (other): Brain fog, blurry vision, chest pain, lung pain with inspiration, extreem shortness of breath with activity, my skin feels like its on fire.
Release 10 — day 7, dose 1
Systemic reaction (other): Brain fog, mixing up words, shortness if breath with activity
Release 10 — day 35, dose 1
Symptoms: I havent gotten a period. Still short of breath with any activity. My resting pulse is 15 higher than prior to vaccination. Hair is falling out. Brain fog. I'm mixing up words and letters
Release 12 — days 1–6 daily, dose 1
Systemic reaction (other): Brain fog, extreme shortness of breath with activity, mixing up words, blurry vision, swollen eyelids. Chest apin and burning on inspiration
Release 12 — 12 months, dose 1
Symptoms: I am short of breath with chest pain any time i exert myself. Anytime my heat rate goes about 100. (My resting HR used to be 50 is now high 60s to 70s even 80s occasionally.
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 | Alopecia | · | · | ✓ |
| SD | Aphasia | · | · | ✓ |
| SD | Brain fog | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Dyspnoea exertional | · | · | ✓ |
| SD | Heart rate increased | · | · | ✓ |
| SD | Menstruation irregular | · | · | ✓ |
| SRO | Back pain | · | · | ✓ |
| SRO | Brain fog | · | · | ✓ |
| SRO | Breast pain | · | · | ✓ |
| SRO | Burning sensation | · | · | ✓ |
| SRO | Chest pain | · | · | ✓ |
| SRO | Disorganised speech | · | · | ✓ |
| SRO | Dyspnoea | · | · | ✓ |
| SRO | Dyspnoea exertional | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
| SRO | Painful respiration | · | · | ✓ |
| SRO | Pruritus | · | · | ✓ |
| SRO | Pulmonary pain | · | · | ✓ |
| SRO | Respiratory disorder | · | · | ✓ |
| SRO | Skin burning sensation | · | · | ✓ |
| SRO | Swelling of eyelid | · | · | ✓ |
| SRO | Vision blurred | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release