6VR-12911-61734
4 vaccinations
4 coded responses
38 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 985 / WA
- Registered
- 2021-03-07
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-25
Dose 1 — Moderna
-
2021-03-07
Registered in v-safe
- 2021-03-07
- 2021-03-11
- 2021-03-18
-
2021-03-24
Dose 2 — Moderna
-
2021-03-25
Survey response — days 1–6 daily, dose 2MedDRA: Acne — Feeling: Good · Site: Pain · Muscle or body achesFree text: Have had acne since first dose, not sure of cause.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-26
Survey response — days 1–6 daily, dose 2MedDRA: Injection site pain — Feeling: Good · Muscle or body achesFree text: Mild soreness at injection site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-03-30
- 2021-03-31
- 2021-04-07
- 2021-04-16
- 2021-04-21
- 2021-04-28
- 2021-05-06
- 2021-06-23
- 2021-09-22
-
2021-10-25
Dose 3 — Moderna
- 2021-10-26
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
-
2021-11-08
Survey response — day 14, dose 3MedDRA: Atrial fibrillation, Bradycardia, Emergency care, Syncope — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Fainted in bathroom at 4 am on 11/04/21. Husband called 911. Was in ER 7 hours due to atrial fibrillation. Discharged home with Rx for Eliquis and Atenolol. Felt fine for 24 hours. Fainted at 3 pm. ER at 4, diagnosed bradycardia. Cardio appt 2 weeksMedDRA releases: 2024-11 · check-in free text available
-
2021-11-08
Report sent to call center — day 14, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2021-11-10
- 2021-11-15
- 2021-11-24
- 2021-11-29
- 2021-12-06
-
2022-01-24
Survey response — 3 months, dose 3MedDRA: Anxiety, Cough, Depressed mood, Fatigue, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea — Feeling: GoodFree text: Had sore throat & coughing, then head congestion & dripping nose. Never had a fever, but was really tired & took my temperature a couple times daily. Was worried & sad for 3 days, then started to feel a little better each day for a week.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-06
Dose 4 — Moderna
- 2022-04-14
- 2022-04-20
- 2022-04-27
- 2022-05-04
- 2022-05-11
- 2022-05-18
- 2022-07-06
- 2023-04-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-25 | Moderna | |
| 2 | 2021-03-24 | Moderna | |
| 3 | 2021-10-25 | Moderna | No |
| 4 | 2022-04-06 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Have had acne since first dose, not sure of cause.
Systemic reaction (other): Mild soreness at injection site.
Release 10 — day 14, dose 3
Symptoms: Fainted in bathroom at 4 am on 11/04/21. Husband called 911. Was in ER 7 hours due to atrial fibrillation. Discharged home with Rx for Eliquis and Atenolol. Felt fine for 24 hours. Fainted at 3 pm. ER at 4, diagnosed bradycardia. Cardio appt 2 weeks cut off by CDC
Release 11 — 3 months, dose 3
Symptoms: Had sore throat & coughing, then head congestion & dripping nose. Never had a fever, but was really tired & took my temperature a couple times daily. Was worried & sad for 3 days, then started to feel a little better each day for a week.
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 | Anxiety | · | · | ✓ |
| SD | Atrial fibrillation | · | · | ✓ |
| SD | Bradycardia | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Depressed mood | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Syncope | · | · | ✓ |
| SRO | Acne | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release