UB4-10713-40905
2 vaccinations
1 coded response
4 check-ins
1 free-text entry
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 062 / CT
- Registered
- 2021-02-18
- Relationship
- Self
- Race
- Other
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-14
Dose 1 — Moderna
-
2021-02-16
Dose 2 — Moderna
-
2021-02-18
Registered in v-safe
- 2021-02-21
- 2021-02-25
- 2021-08-20
-
2022-02-16
Survey response — 12 months, dose 2MedDRA: Abdominal pain, Ageusia, Anosmia, Fatigue, Headache, Medical counselling, Nausea, Pregnancy, Pyrexia, SARS-CoV-2 test negative, Vomiting — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Pregnancy- (negative covid test) fatigue, vomiting, nausea, fever, headache, abdominal pain, loss of smell & taste · Healthcare visit (other): phone consultsMedDRA releases: 2024-11 · check-in free text available
-
2022-02-16
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-02-17
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-14 | Moderna | |
| 2 | 2021-02-16 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 11 — 12 months, dose 2
Symptoms: Pregnancy- (negative covid test) fatigue, vomiting, nausea, fever, headache, abdominal pain, loss of smell & taste
Healthcare visit (other): phone consults
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 | Medical counselling | · | · | ✓ |
| SD | Abdominal pain | · | · | ✓ |
| SD | Ageusia | · | · | ✓ |
| SD | Anosmia | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Pregnancy | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release