6JX-16938-93585
2 vaccinations
4 coded responses
25 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 795 / TX
- Registered
- 2021-07-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-07-16
Dose 1 — Moderna
-
2021-07-17
Registered in v-safe
-
2021-07-17
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain, Rash, not including the immediate area around the injection siteAdult check-in
-
2021-07-18
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-07-19
Health check-in — days 1–6 daily, dose 1Feeling: Good · Headache, Fatigue or tirednessAdult check-in
-
2021-07-20
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-07-21
- 2021-07-22
- 2021-07-23
- 2021-07-30
- 2021-08-06
-
2021-08-13
Dose 2 — Moderna
- 2021-08-13
-
2021-08-14
Survey response — days 1–6 daily, dose 2MedDRA: Blood glucose increased, Diabetes mellitus, Pre-existing disease — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessFree text: Type 1 diabetic - sugars have been high today - have only eaten toastMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-15
Survey response — days 1–6 daily, dose 2MedDRA: Blood glucose increased, Chills, Headache, Night sweats, Pain, Pyrexia, Sensitive skin — Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessFree text: Yesterday - late afternoon and night was really bad - I was running a low grade fever - chills - headache - body aches - sensitive skin and hi blood sugars - around 11 pm I woke up in a sweat - my fever had broke and my sugars returned to normalMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-16
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
-
2021-08-17
Survey response — days 1–6 daily, dose 2MedDRA: Blood glucose increased — Feeling: Fair · Headache, Fatigue or tirednessFree text: Have had hi blood sugars for 3 straight days - couldnt get them down - finally are better today!MedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-08-18
-
2021-08-19
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fatigue or tiredness, Abdominal painAdult check-in
- 2021-08-20
- 2021-08-27
- 2021-09-03
- 2021-09-10
- 2021-09-17
-
2021-09-24
Survey response — day 42, dose 2MedDRA: Office visit, Peripheral arterial occlusive disease — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Found out, In the last month, I have plaque build up in my lower extremities. · Healthcare visit (other): Office visit with my primary care physicianMedDRA releases: 2024-11 · check-in free text available
-
2021-09-24
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-28
-
2021-10-06
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-11-12
- 2022-02-11
- 2022-08-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-07-16 | Moderna | No |
| 2 | 2021-08-13 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 9 — days 1–6 daily, dose 2
Systemic reaction (other): Type 1 diabetic - sugars have been high today - have only eaten toast
Systemic reaction (other): Yesterday - late afternoon and night was really bad - I was running a low grade fever - chills - headache - body aches - sensitive skin and hi blood sugars - around 11 pm I woke up in a sweat - my fever had broke and my sugars returned to normal
Systemic reaction (other): Have had hi blood sugars for 3 straight days - couldnt get them down - finally are better today!
Release 9 — day 42, dose 2
Symptoms: Found out, In the last month, I have plaque build up in my lower extremities.
Healthcare visit (other): Office visit with my primary care physician
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 | Peripheral arterial occlusive disease | · | · | ✓ |
| SRO | Blood glucose increased | ✓ | · | ✓ |
| SRO | Chills | ✓ | · | ✓ |
| SRO | Diabetes mellitus | ✓ | · | ✓ |
| SRO | Headache | ✓ | · | ✓ |
| SRO | Night sweats | ✓ | · | ✓ |
| SRO | Pain | ✓ | · | ✓ |
| SRO | Pre-existing disease | ✓ | · | ✓ |
| SRO | Pyrexia | ✓ | · | ✓ |
| SRO | Sensitive skin | ✓ | · | ✓ |
| SRO | Type 1 diabetes mellitus | ○ | · | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release