C62-30915-43494
5 vaccinations
8 coded responses
42 check-ins
8 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 26-30
- ZIP prefix
- 282 / NC
- Registered
- 2021-03-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
ALJ-36841-05383
Child or adolescent in my care · Female · 2022-06-28
Timeline
-
2021-03-08
Dose 1 — Moderna
-
2021-03-09
Registered in v-safe
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-14
- 2021-03-15
- 2021-03-24
- 2021-03-29
-
2021-04-05
Dose 2 — Moderna
- 2021-04-05
-
2021-04-06
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness, Headache, Self-medication — Feeling: Poor · Site: Pain, Redness · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Diarrhea, Rash, not including the immediate area around the injection site · Be unable to work, Be unable to do your normal daily activitiesFree text: Dizziness soon after injection. Headache wont go away with extra strength Tylenol, nor will feverMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-07
Survey response — days 1–6 daily, dose 2MedDRA: Night sweats — Feeling: Good · Site: Pain, RednessFree text: Woke up with severe night sweats at 4 am. Felt completely fine otherwiseMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-08
Survey response — days 1–6 daily, dose 2MedDRA: Axillary pain, Discomfort — Feeling: Good · Site: PainFree text: Pain/discomfort in armpitMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-09
Survey response — days 1–6 daily, dose 2MedDRA: Axillary pain — Feeling: Good · Site: PainFree text: Still underarm pain.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-10
- 2021-04-11
- 2021-04-12
- 2021-04-19
- 2021-04-26
- 2021-05-03
- 2021-05-10
- 2021-05-17
- 2021-07-05
-
2021-08-31
Dose 3 — Moderna
- 2021-10-04
- 2021-11-30
-
2022-02-24
Dose 4 — Moderna
- 2022-03-01
-
2022-03-01
Survey response — 6 months, dose 3MedDRA: Pre-existing disease — Feeling: Good · 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 consultation, Outpatient clinic or urgent care clinic visitFree text: COVID positive on 1/22/2022. Positive pregnancy test on 1/25/2022. Pregnancy confirmed via ultrasound 2/16/2022. Confirmed miscarriage on 2/18/2022. 4th COVID vaccine 2/24/2022MedDRA releases: 2024-11 · check-in free text available
-
2022-03-01
Report sent to call center — 6 months, dose 3Be 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-03-02
-
2022-03-03
Survey response — day 7, dose 4MedDRA: Vomiting — Feeling: Poor · Site: Pain · Vomiting · Be unable to work or attend schoolFree text: I don't think it's related to the vaccine. I think it was something I ate. Vomited 4x in an hourMedDRA releases: 2024-11 · check-in free text available
- 2022-03-03
-
2022-03-03
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-03-10
- 2022-03-17
- 2022-03-24
- 2022-04-02
- 2022-04-07
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2022-05-26
Survey response — 3 months, dose 4MedDRA: Abscess neck — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Abscess on neck, likely related to the biologic I take (Remicade) vs. the vaccineMedDRA releases: 2024-11 · check-in free text available
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2022-05-26
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-05-27
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-07-29
Dose 5 — Moderna
- 2022-08-04
- 2022-08-05
- 2022-08-12
- 2022-08-21
- 2022-08-26
- 2022-09-02
- 2022-09-09
-
2022-10-28
Survey response — 3 months, dose 5MedDRA: Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Stuffy nose and sore throat. Negative for COVID and strep.MedDRA releases: 2024-11 · check-in free text available
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2022-10-28
Report sent to call center — 3 months, dose 5Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-10-31
- 2023-01-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-08 | Moderna | |
| 2 | 2021-04-05 | Moderna | |
| 3 | 2021-08-31 | Moderna | No |
| 4 | 2022-02-24 | Moderna | No |
| 5 | 2022-07-29 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-03-01 | Successful 2022-03-03 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-05-26 | Successful 2022-05-27 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-10-28 | Unsuccessful |
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Dizziness soon after injection. Headache wont go away with extra strength Tylenol, nor will fever
Systemic reaction (other): Woke up with severe night sweats at 4 am. Felt completely fine otherwise
Systemic reaction (other): Pain/discomfort in armpit
Systemic reaction (other): Still underarm pain.
Release 11 — 6 months, dose 3
Symptoms: COVID positive on 1/22/2022. Positive pregnancy test on 1/25/2022. Pregnancy confirmed via ultrasound 2/16/2022. Confirmed miscarriage on 2/18/2022. 4th COVID vaccine 2/24/2022
Release 11 — day 7, dose 4
Systemic reaction (other): I don't think it's related to the vaccine. I think it was something I ate. Vomited 4x in an hour
Release 11 — 3 months, dose 4
Symptoms: Abscess on neck, likely related to the biologic I take (Remicade) vs. the vaccine
Release 12 — 3 months, dose 5
Symptoms: Stuffy nose and sore throat. Negative for COVID and strep.
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 | Abscess neck | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Axillary pain | ✓ | ✓ | ✓ |
| SRO | Discomfort | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Night sweats | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Vomiting | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release