79V-24907-87680
4 vaccinations
3 coded responses
51 check-ins
2 free-text entries
0 call cases
- Sex
- —
- Age at first dose
- 36-40
- ZIP prefix
- 980 / WA
- Registered
- 2021-03-18
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Registered dependents
XRQ-22037-14344
Child or adolescent in my care · · 2022-06-24
Timeline
-
2021-03-17
Dose 1 — Moderna
-
2021-03-18
Registered in v-safe
-
2021-03-18
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-03-24
- 2021-03-31
- 2021-04-07
-
2021-04-14
Dose 2 — Moderna
- 2021-04-14
-
2021-04-15
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tiredness, NauseaAdult check-in
- 2021-04-16
- 2021-04-17
- 2021-04-19
- 2021-04-20
- 2021-04-21
- 2021-04-28
- 2021-05-05
- 2021-05-12
- 2021-05-19
- 2021-05-26
- 2021-07-14
- 2021-10-13
-
2021-11-08
Dose 3 — Moderna
- 2021-11-09
-
2021-11-10
Survey response — days 1–6 daily, dose 3MedDRA: Musculoskeletal stiffness — Feeling: Good · Site: Pain, Swelling · Muscle or body achesFree text: Neck stiffnessMedDRA releases: 2024-11 · check-in free text available
- 2021-11-11
- 2021-11-12
- 2021-11-13
- 2021-11-14
- 2021-11-16
- 2021-11-22
- 2021-11-29
- 2021-12-06
- 2021-12-14
- 2021-12-20
- 2022-02-07
- 2022-05-10
-
2022-10-29
Dose 4 — ModernaCo-administered: Flu
-
2022-10-29
Health check-in — day 0, dose 4Feeling: Good · Site: Pain, Swelling · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-10-30
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2022-10-31
- 2022-11-01
- 2022-11-02
- 2022-11-03
- 2022-11-04
- 2022-11-05
- 2022-11-12
- 2022-11-19
- 2022-11-28
-
2022-12-03
Survey response — day 35, dose 4MedDRA: Ageusia, Anosmia, Cough, Respiratory tract congestion, Sneezing — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Congestion, cough, sneezing, loss of taste, loss of smellMedDRA releases: 2024-11 · check-in free text available
- 2022-12-10
-
2023-01-30
Survey response — 3 months, dose 4MedDRA: Nasopharyngitis, Respiratory tract congestion — Feeling: GoodMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-17 | Moderna | |
| 2 | 2021-04-14 | Moderna | |
| 3 | 2021-11-08 | Moderna | No |
| 4 | 2022-10-29 | Moderna | Flu |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Neck stiffness
Release 12 — day 35, dose 4
Symptoms: Congestion, cough, sneezing, loss of taste, loss of smell
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 | Ageusia | · | · | ✓ |
| SD | Anosmia | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Musculoskeletal stiffness | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release