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K9E-14574-14102

5 vaccinations 7 coded responses 49 check-ins 7 free-text entries 2 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
605 / IL
Registered
2021-02-28
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-13
    Dose 1 — Moderna
  2. 2021-02-28
    Registered in v-safe
  3. 2021-02-28
    Survey response — day 14, dose 1
    MedDRA: Injection site swelling, Nausea, Pain, Rash erythematous, Rash pruritic, Self-medication — Feeling: Good
    Free text: About Feb 20 swelling of injection site which resolved about Feb 21. Red rash on arm beginning Feb 21 ongoing. Rash itching today. Mild nausea and aches Feb 27 that resolved with Tylenol.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-03-06
    Health check-in — day 21, dose 1
    Feeling: Fair
    Adult check-in
  5. 2021-03-13
    Dose 2 — Moderna
  6. 2021-03-13
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  7. 2021-03-14
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities
    Adult check-in
  8. 2021-03-15
    Survey response — days 1–6 daily, dose 2
    MedDRA: Injection site pain — Feeling: Good
    Free text: Just some soreness at the injection site
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-03-16
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Redness · None
    Adult check-in
  10. 2021-03-17
    Survey response — days 1–6 daily, dose 2
    MedDRA: No adverse event — Feeling: Good · Rash, not including the immediate area around the injection site
    Free text: No
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-03-18
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Rash, not including the immediate area around the injection site
    Adult check-in
  12. 2021-03-19
    Survey response — days 1–6 daily, dose 2
    MedDRA: Rash — Feeling: Good · Rash, not including the immediate area around the injection site
    Free text: Rash is almost gone on left arm and noticeably lighter on right arm.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-03-20
    Survey response — day 7, dose 2
    MedDRA: Erythema — Feeling: Good · Rash, not including the immediate area around the injection site
    Free text: Red on left arm is gone; right arm shows some redness but fading
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-03-27
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-04-03
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-04-10
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-04-17
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-04-25
    Survey response — day 42, dose 2
    MedDRA: Extrasystoles, Heart rate irregular — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Routine check up showed Regularly irregular heartbeat. Follow up tests revealed ectopic heart beats. No notice of this at my December 2020 exam.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-04-25
    Report sent to call center — day 42, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  20. 2021-06-12
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-09-13
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-10-25
    Dose 3 — Moderna
    Co-administered: Flu
  23. 2021-10-28
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  24. 2021-10-29
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  25. 2021-10-30
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  26. 2021-10-31
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  27. 2021-11-01
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  28. 2021-11-17
    Survey response — day 21, dose 3
    MedDRA: Abdominal discomfort, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional
    Free text: Symptoms: Stomach distress · Healthcare visit (other): Appt scheduled for tomorrow
    MedDRA releases: 2024-11 · check-in free text available
  29. 2021-11-17
    Report sent to call center — day 21, dose 3
    Get care from a doctor or other healthcare professional
    1 call case(s)
  30. 2021-11-18
  31. 2021-11-22
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  32. 2021-11-29
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  33. 2021-12-06
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  34. 2022-01-24
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  35. 2022-04-27
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  36. 2022-06-14
    Dose 4 — Moderna
  37. 2022-06-14
    Health check-in — day 0, dose 4
    Feeling: Good · None
    Adult check-in
  38. 2022-06-15
    Health check-in — days 1–6 daily, dose 4
    Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, Nausea
    Adult check-in
  39. 2022-06-16
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Muscle or body aches
    Adult check-in
  40. 2022-06-17
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  41. 2022-06-18
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  42. 2022-06-19
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  43. 2022-06-20
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  44. 2022-06-21
    Health check-in — day 7, dose 4
    Feeling: Good · None
    Adult check-in
  45. 2022-06-28
    Health check-in — day 14, dose 4
    Feeling: Good
    Adult check-in
  46. 2022-07-05
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  47. 2022-07-12
    Health check-in — day 28, dose 4
    Feeling: Good
    Adult check-in
  48. 2022-07-19
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  49. 2022-07-26
    Health check-in — day 42, dose 4
    Feeling: Good
    Adult check-in
  50. 2022-10-06
    Dose 5 — Moderna
    Co-administered: Flu
  51. 2022-10-16
    Health check-in — day 7, dose 5
    Feeling: Good · None
    Adult check-in
  52. 2022-10-20
    Health check-in — day 14, dose 5
    Feeling: Good
    Adult check-in
  53. 2022-10-27
    Health check-in — day 21, dose 5
    Feeling: Good
    Adult check-in
  54. 2022-11-03
    Health check-in — day 28, dose 5
    Feeling: Good
    Adult check-in
  55. 2022-11-10
    Health check-in — day 35, dose 5
    Feeling: Good
    Adult check-in
  56. 2022-11-17
    Health check-in — day 42, dose 5
    Feeling: Good
    Adult check-in
  57. 2023-01-05
    Health check-in — 3 months, dose 5
    Feeling: Good
    Adult check-in
  58. 2023-04-06
    Health check-in — 6 months, dose 5
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-02-13Moderna
22021-03-13Moderna
32021-10-25Moderna Flu
42022-06-14Moderna No
52022-10-06Moderna Flu

Call center

ReportedOutcomeVAERS-related outcome
2021-04-25 Unsuccessful
2021-11-17 Unsuccessful

Free text

Release 4 — day 14, dose 1

2021-02-28

Symptoms: About Feb 20 swelling of injection site which resolved about Feb 21. Red rash on arm beginning Feb 21 ongoing. Rash itching today. Mild nausea and aches Feb 27 that resolved with Tylenol.

Release 5 — days 1–6 daily, dose 2

2021-03-15

Systemic reaction (other): Just some soreness at the injection site

2021-03-17

Systemic reaction (other): No

2021-03-19

Systemic reaction (other): Rash is almost gone on left arm and noticeably lighter on right arm.

Release 6 — day 7, dose 2

2021-03-20

Systemic reaction (other): Red on left arm is gone; right arm shows some redness but fading

Release 7 — day 42, dose 2

2021-04-25

Symptoms: Routine check up showed Regularly irregular heartbeat. Follow up tests revealed ectopic heart beats. No notice of this at my December 2020 exam.

Release 10 — day 21, dose 3

2021-11-17

Symptoms: Stomach distress
Healthcare visit (other): Appt scheduled for tomorrow

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
HCVOUnevaluable event · · ✓
SDAbdominal discomfort · · ✓
SDExtrasystoles ✓ ✓ ✓
SDHeart rate irregular ✓ ✓ ✓
SDInjection site swelling ✓ ✓ ✓
SDNausea ✓ ✓ ✓
SDPain ✓ ✓ ✓
SDRash erythematous ✓ ✓ ✓
SDRash pruritic ✓ ✓ ✓
SDSelf-medication ✓ ✓ ✓
SROErythema ✓ ✓ ✓
SROInjection site pain ✓ ✓ ✓
SRONo adverse event ✓ ✓ ✓
SRORash ✓ ✓ ✓

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

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