76Z-17620-77321
4 vaccinations
4 coded responses
30 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 070 / NJ
- Registered
- 2021-04-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-02
Registered in v-safe
-
2021-04-02
Dose 1 — Moderna
- 2021-04-02
-
2021-04-03
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-04-04
Health check-in — days 1–6 daily, dose 1Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-08
- 2021-04-09
-
2021-04-16
Survey response — day 14, dose 1MedDRA: Injection site rash — Feeling: GoodFree text: I developed a mild rash near the injection site on day 8. Had I not seen it, I wouldnt have known it was there - no pain/itching/etc. It went away after a few days.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-23
-
2021-04-30
Dose 2 — Moderna
- 2021-04-30
-
2021-05-01
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-05-02
Survey response — days 1–6 daily, dose 2MedDRA: Asthenia, Dizziness, Injection site rash — Feeling: Fair · Site: Pain, Redness · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Rash near injection site, feeling a bit weak and light-headedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-03
Survey response — days 1–6 daily, dose 2MedDRA: Injection site rash — Feeling: Fair · Site: Pain · HeadacheFree text: Rash near injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-04
- 2021-05-05
- 2021-05-06
- 2021-05-07
- 2021-05-17
- 2021-05-23
- 2021-05-28
- 2021-06-04
- 2021-06-11
- 2021-08-01
- 2021-10-29
-
2021-11-26
Dose 3 — Moderna
- 2022-04-30
-
2022-09-30
Dose 4 — Pfizer-BioNTech
- 2022-10-22
-
2022-10-31
Survey response — day 28, dose 4MedDRA: Delivery — 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 · HospitalizationFree text: Delivered a babyMedDRA releases: 2024-11 · check-in free text available
-
2022-10-31
Report sent to call center — day 28, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prHospitalization · 1 call case(s)
-
2022-11-02
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-13
- 2023-01-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-02 | Moderna | |
| 2 | 2021-04-30 | Moderna | |
| 3 | 2021-11-26 | Moderna | No |
| 4 | 2022-09-30 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-31 | Successful 2022-11-02 |
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: I developed a mild rash near the injection site on day 8. Had I not seen it, I wouldnt have known it was there - no pain/itching/etc. It went away after a few days.
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Rash near injection site, feeling a bit weak and light-headed
Systemic reaction (other): Rash near injection site
Release 12 — day 28, dose 4
Symptoms: Delivered a baby
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 | Delivery | · | · | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SRO | Asthenia | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Injection site rash | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release