PA8-10249-07895
1 vaccination
3 coded responses
4 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 483 / MI
- Registered
- 2021-02-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-28
Dose 1 — Moderna
-
2021-02-09
Registered in v-safe
-
2021-02-09
Survey response — day 7, dose 1MedDRA: Injection site induration, Injection site mass, Injection site pain, Injection site warmth — Feeling: Good · Site: Pain, Redness, Swelling, Itching · HeadacheFree text: Pain, hard lump and warmness at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-11
Survey response — day 14, dose 1MedDRA: Feeling hot, Rash — Feeling: GoodFree text: Large arm rash that is firm to touch and warmMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-18
-
2022-01-28
Survey response — 12 months, dose 1MedDRA: Nephrolithiasis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Kidney stonesMedDRA releases: 2024-11 · check-in free text available
-
2022-01-28
Report sent to call center — 12 months, dose 1Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-01-31
- 2022-02-03
-
2022-02-03
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-28 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 3 — day 7, dose 1
Systemic reaction (other): Pain, hard lump and warmness at injection site
Release 4 — day 14, dose 1
Symptoms: Large arm rash that is firm to touch and warm
Release 11 — 12 months, dose 1
Symptoms: Kidney stones
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 | Feeling hot | ✓ | ✓ | ✓ |
| SD | Nephrolithiasis | · | · | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SRO | Injection site induration | ✓ | ✓ | ✓ |
| SRO | Injection site mass | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Injection site warmth | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release