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CMX-11033-34709

4 vaccinations 6 coded responses 19 check-ins 6 free-text entries 0 call cases
Sex
Female
Age at first dose
26-30
ZIP prefix
840 / UT
Registered
2021-03-31
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino
Registered dependents
9UL-33854-53812 Child or adolescent in my care · Male · 2022-06-27

Timeline

  1. 2021-03-30
    Dose 1 — Moderna
  2. 2021-03-31
    Registered in v-safe
  3. 2021-03-31
    Survey response — days 1–6 daily, dose 1
    MedDRA: Swelling of eyelid — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities
    Free text: Swollen eyelids
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-04-01
    Survey response — days 1–6 daily, dose 1
    MedDRA: Swelling of eyelid — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site
    Free text: Eyelid swelling
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-04-03
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Rash, not including the immediate area around the injection site
    Adult check-in
  6. 2021-04-06
    Health check-in — day 7, dose 1
    Feeling: Good · Rash, not including the immediate area around the injection site
    Adult check-in
  7. 2021-04-13
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  8. 2021-04-20
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  9. 2021-04-27
    Survey response — day 28, dose 1
    MedDRA: Eyelid rash — Feeling: Good
    Free text: The rashes on my eyelids are still present.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-04-28
    Dose 2 — Moderna
  11. 2021-04-28
    Health check-in — day 0, dose 2
    Feeling: Good · Site: Pain, Redness, Swelling · Headache
    Adult check-in
  12. 2021-04-29
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  13. 2021-04-30
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Itching · Headache
    Adult check-in
  14. 2021-05-01
    Survey response — days 1–6 daily, dose 2
    MedDRA: Lymphadenopathy — Feeling: Good · Site: Pain · Headache
    Free text: Swollen lymphnode in neck
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-05-02
    Survey response — days 1–6 daily, dose 2
    MedDRA: Lymphadenopathy — Feeling: Good · Headache
    Free text: Swollen lymphnode in neck
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-05-03
    Survey response — days 1–6 daily, dose 2
    MedDRA: Dizziness — Feeling: Fair · Headache, Nausea
    Free text: Light headed
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-05-04
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Headache
    Adult check-in
  18. 2021-05-28
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  19. 2021-06-05
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-07-28
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-10-27
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-11-22
    Dose 3 — Pfizer-BioNTech
  23. 2022-06-12
    Dose 4 — Pfizer-BioNTech
  24. 2022-06-27
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-03-30Moderna
22021-04-28Moderna
32021-11-22Pfizer-BioNTech No
42022-06-12Pfizer-BioNTech No

Free text

Release 6 — days 1–6 daily, dose 1

2021-03-31

Systemic reaction (other): Swollen eyelids

2021-04-01

Systemic reaction (other): Eyelid swelling

Release 8 — day 28, dose 1

2021-04-27

Symptoms: The rashes on my eyelids are still present.

Release 8 — days 1–6 daily, dose 2

2021-05-01

Systemic reaction (other): Swollen lymphnode in neck

2021-05-02

Systemic reaction (other): Swollen lymphnode in neck

2021-05-03

Systemic reaction (other): Light headed

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

FieldPreferred term2021-092023-042024-11
SDEyelid rash ✓ ✓ ✓
SRODizziness ✓ ✓ ✓
SROLymphadenopathy ✓ ✓ ✓
SROSwelling of eyelid ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release

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