EBH-21653-56065
2 vaccinations
4 coded responses
24 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 208 / MD
- Registered
- 2021-01-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
QXS-23054-00698
Child or adolescent in my care · Male · 2022-02-11
Timeline
-
2021-01-12
Registered in v-safe
-
2021-01-12
Dose 1 — Moderna
- 2021-01-12
-
2021-01-13
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: PainFree text: Pain/muscle pain in deltoid at injection aiteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-14
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-27
- 2021-02-03
-
2021-02-09
Dose 2 — Moderna
- 2021-02-09
-
2021-02-10
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-02-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fever · Fatigue or tirednessAdult check-in
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-17
- 2021-02-24
- 2021-03-02
- 2021-03-11
- 2021-03-18
- 2021-03-23
-
2021-05-11
Survey response — 3 months, dose 2MedDRA: Chills, Fatigue, Nasal congestion, SARS-CoV-2 test negative, Sinus congestion — Feeling: GoodFree text: Chills, nasal and sinus congestion and fatigue 3 daystested for covid and negativeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-08-10
Survey response — 6 months, dose 2MedDRA: Cough, Nasopharyngitis, Pregnancy — Feeling: Good · Be unable to do your normal daily activitiesFree text: had a transient cold/cougham pregnant nowMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2022-02-11
Survey response — 12 months, dose 2MedDRA: Abortion spontaneous, Surgery — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: -miscarriage in Sept 2022 · Healthcare visit (other): Outpatient procedureMedDRA releases: 2024-11 · check-in free text available
-
2022-02-11
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2022-02-16
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-12 | Moderna | |
| 2 | 2021-02-09 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-11 | Successful 2022-02-16 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Pain/muscle pain in deltoid at injection aite
Release 8 — 3 months, dose 2
Symptoms: Chills, nasal and sinus congestion and fatigue 3 daystested for covid and negative
Release 9 — 6 months, dose 2
Symptoms: had a transient cold/cougham pregnant now
Release 11 — 12 months, dose 2
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 |
|---|---|---|---|---|
| HCVO | Surgery | · | · | ✓ |
| SD | Abortion spontaneous | · | · | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Cough | ✓ | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Nasal congestion | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | · | ✓ |
| SD | Pregnancy | ✓ | · | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SD | Sinus congestion | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release