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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

  1. 2021-01-28
    Dose 1 — Moderna
  2. 2021-02-09
    Registered in v-safe
  3. 2021-02-09
    Survey response — day 7, dose 1
    MedDRA: Injection site induration, Injection site mass, Injection site pain, Injection site warmth — Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache
    Free text: Pain, hard lump and warmness at injection site
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-11
    Survey response — day 14, dose 1
    MedDRA: Feeling hot, Rash — Feeling: Good
    Free text: Large arm rash that is firm to touch and warm
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-02-18
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  6. 2022-01-28
    Survey response — 12 months, dose 1
    MedDRA: 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, Hospitalization
    Free text: Kidney stones
    MedDRA releases: 2024-11 · check-in free text available
  7. 2022-01-28
    Report sent to call center — 12 months, dose 1
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Emergency room or emergency department visit · Hospitalization · 1 call case(s)
  8. 2022-01-31
  9. 2022-02-03
  10. 2022-02-03
    Call successful
    Does not wish to fill out VAERS report

Vaccinations

DoseDateManufacturerCo-administered
12021-01-28Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 3 — day 7, dose 1

2021-02-09

Systemic reaction (other): Pain, hard lump and warmness at injection site

Release 4 — day 14, dose 1

2021-02-11

Symptoms: Large arm rash that is firm to touch and warm

Release 11 — 12 months, dose 1

2022-01-28

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

FieldPreferred term2021-092023-042024-11
SDFeeling hot ✓ ✓ ✓
SDNephrolithiasis · · ✓
SDRash ✓ ✓ ✓
SROInjection site induration ✓ ✓ ✓
SROInjection site mass ✓ ✓ ✓
SROInjection site pain ✓ ✓ ✓
SROInjection site warmth ✓ ✓ ✓

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