B99-11074-10655
2 vaccinations
6 coded responses
23 check-ins
6 free-text entries
8 call cases
- Sex
- Female
- Age at first dose
- 21-25
- ZIP prefix
- 826 / WY
- Registered
- 2020-12-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2020-12-28
Registered in v-safe
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2020-12-28
Dose 1 — Moderna
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2020-12-28
Health check-in — day 0, dose 1Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2020-12-29
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
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2020-12-30
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea · Be unable to do your normal daily activitiesAdult check-in
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2020-12-30
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities1 call case(s)
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2020-12-31
Survey response — days 1–6 daily, dose 1MedDRA: Diplopia — Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: Double visionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2020-12-31
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities1 call case(s)
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2021-01-01
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-01-01
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities1 call case(s)
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2021-01-02
Survey response — days 1–6 daily, dose 1MedDRA: Dizziness — Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-02
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities1 call case(s)
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2021-01-03
Survey response — days 1–6 daily, dose 1MedDRA: Dizziness — Feeling: Poor · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-03
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities1 call case(s)
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2021-01-04
Health check-in — day 7, dose 1Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitAdult check-in
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2021-01-04
Report sent to call center — day 7, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-01-11
Survey response — day 14, dose 1MedDRA: Arthralgia, Diarrhoea, Influenza, Injection site urticaria, Pyrexia, Vomiting — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Vomiting, diarrhea, fever, hives under vaccine injection site, joint pain, influenzaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-11
Report sent to call center — day 14, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-01-18
- 2021-01-25
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2021-01-29
Dose 2 — Moderna
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2021-02-01
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Chills, Injection site urticaria, Pyrexia — Feeling: Fair · Site: Redness, Swelling, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, NauseaFree text: On 1/30/21 chills were severe, fever of 106, hives at injection site. Today is better but still difficult to handle the joint pain and chills.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-02
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-02-02
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2021-02-02
Call successfulCompleted over the phone
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2021-02-03
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Itching · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-02-05
Health check-in — day 7, dose 2Feeling: Fair · Site: Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-02-12
- 2021-02-21
- 2021-02-26
- 2021-03-05
- 2021-03-12
- 2021-04-30
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2021-07-30
Survey response — 6 months, dose 2MedDRA: Depression — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: DepressionMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-07-30
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-04
- 2022-01-31
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-28 | Moderna | |
| 2 | 2021-01-29 | Moderna |
Call center
8 call center cases
7 successful · 1 unsuccessful
VAERS report filed, before or during a call: 7
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Double vision
Systemic reaction (other): Dizziness
Systemic reaction (other): Dizziness
Release 1 — day 14, dose 1
Symptoms: Vomiting, diarrhea, fever, hives under vaccine injection site, joint pain, influenza
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): On 1/30/21 chills were severe, fever of 106, hives at injection site. Today is better but still difficult to handle the joint pain and chills.
Release 9 — 6 months, dose 2
Symptoms: Depression
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 | Arthralgia | ✓ | ✓ | ✓ |
| SD | Depression | ✓ | · | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Influenza | ✓ | ✓ | ✓ |
| SD | Injection site urticaria | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Vomiting | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Diplopia | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Injection site urticaria | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release