87X-14666-57168
2 vaccinations
6 coded responses
26 check-ins
6 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 070 / NJ
- Registered
- 2021-01-29
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
KU4-52582-74657
Child or adolescent in my care · Male · 2022-08-02
SKC-10273-55871
Child or adolescent in my care · Male · 2022-08-02
Timeline
-
2021-01-29
Registered in v-safe
-
2021-01-29
Dose 1 — Moderna
- 2021-01-29
-
2021-01-30
Survey response — days 1–6 daily, dose 1MedDRA: Adverse reaction — Feeling: Good · Site: Pain · Headache, Muscle or body achesFree text: More severe symptoms last night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-12
- 2021-02-21
-
2021-02-26
Dose 2 — Moderna
- 2021-02-26
-
2021-02-27
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-02-28
Survey response — days 1–6 daily, dose 2MedDRA: Oropharyngeal pain, Rhinorrhoea — Feeling: Fair · Site: PainFree text: I have a sore throat and runny nose but believe that is related to my sons cold.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-07
- 2021-03-12
-
2021-03-19
Survey response — day 21, dose 2MedDRA: Discharge, Oropharyngeal pain — Feeling: FairFree text: drainage and slight sore throat.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-26
- 2021-04-02
- 2021-04-09
-
2021-05-28
Survey response — 3 months, dose 2MedDRA: Oropharyngeal pain, Respiratory tract congestion — Feeling: GoodFree text: Sore throat, congestion.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-08-27
Survey response — 6 months, dose 2MedDRA: Iliotibial band syndrome, Multiple fractures — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Three broken bones, torn IT band.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2022-02-26
Survey response — 12 months, dose 2MedDRA: Nasopharyngitis, Sinusitis — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Common cold/sinus infection.MedDRA releases: 2024-11 · check-in free text available
-
2022-02-26
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-03-24
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-29 | Moderna | |
| 2 | 2021-02-26 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): More severe symptoms last night.
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): I have a sore throat and runny nose but believe that is related to my sons cold.
Release 5 — day 21, dose 2
Symptoms: drainage and slight sore throat.
Release 8 — 3 months, dose 2
Symptoms: Sore throat, congestion.
Release 9 — 6 months, dose 2
Symptoms: Three broken bones, torn IT band.
Release 11 — 12 months, dose 2
Symptoms: Common cold/sinus infection.
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 | Discharge | ✓ | ✓ | ✓ |
| SD | Iliotibial band syndrome | ✓ | · | ✓ |
| SD | Multiple fractures | ✓ | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | ✓ | ✓ | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release