6RN-31135-11850
4 vaccinations
5 coded responses
53 check-ins
4 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 144 / NY
- Registered
- 2021-03-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-24
Registered in v-safe
-
2021-03-24
Dose 1 — Moderna
- 2021-03-24
- 2021-03-25
- 2021-03-26
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-03-31
-
2021-04-07
Survey response — day 14, dose 1MedDRA: Choroiditis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Multifocal choroiditisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-07
Report sent to call center — day 14, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-14
- 2021-04-21
-
2021-04-28
Dose 2 — Moderna
- 2021-04-28
-
2021-04-29
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-30
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tirednessAdult check-in
- 2021-05-01
- 2021-05-02
- 2021-05-03
-
2021-05-04
Survey response — days 1–6 daily, dose 2MedDRA: Swelling face — Feeling: FairFree text: Facial swelling - I got stung on the chin by a bee todayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-05
- 2021-05-12
- 2021-05-19
- 2021-05-26
- 2021-06-02
- 2021-06-09
- 2021-07-30
-
2021-10-28
Dose 3 — Moderna
- 2021-10-28
- 2021-10-28
-
2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to work or attend schoolAdult check-in
-
2021-10-30
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-10-31
- 2021-11-01
- 2021-11-03
- 2021-11-06
- 2021-11-13
- 2021-11-18
- 2021-11-25
- 2021-12-02
- 2021-12-09
- 2022-01-13
- 2022-01-27
-
2022-04-28
Survey response — 6 months, dose 3MedDRA: Tinnitus — Feeling: GoodFree text: TinnitusMedDRA releases: 2024-11 · check-in free text available
-
2022-06-08
Dose 4 — Moderna
-
2022-06-09
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-06-11
- 2022-06-12
- 2022-06-13
- 2022-06-14
- 2022-06-15
- 2022-06-22
- 2022-06-29
-
2022-07-06
Survey response — day 28, dose 4MedDRA: Breast mass — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Lump in breastMedDRA releases: 2024-11 · check-in free text available
-
2022-07-06
Report sent to call center — day 28, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-07-07
- 2022-07-07
- 2022-07-15
- 2022-07-20
- 2022-09-09
- 2022-12-07
-
2023-06-10
Survey response — 12 months, dose 4MedDRA: Pregnancy — 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 professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitMedDRA releases: 2024-11
-
2023-06-10
Call case (no matching report) — SuccessfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-06-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-06-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-06-12
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 | 2021-03-24 | Moderna | |
| 2 | 2021-04-28 | Moderna | |
| 3 | 2021-10-28 | Moderna | No |
| 4 | 2022-06-08 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-07 | Successful 2023-06-12 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-07-06 | Successful 2023-06-12 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-06-10 | Successful 2023-06-12 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 7 — day 14, dose 1
Symptoms: Multifocal choroiditis
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Facial swelling - I got stung on the chin by a bee today
Release 11 — 6 months, dose 3
Symptoms: Tinnitus
Release 12 — day 28, dose 4
Symptoms: Lump in breast
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 | Breast mass | · | · | ✓ |
| SD | Choroiditis | ✓ | ✓ | ✓ |
| SD | Pregnancy | · | · | ✓ |
| SD | Tinnitus | · | · | ✓ |
| SRO | Swelling face | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release