UV4-13141-89768
2 vaccinations
4 coded responses
18 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 973 / OR
- Registered
- 2021-01-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
K9X-24326-27703
Child or adolescent in my care · Male · 2022-07-09
Timeline
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2021-01-09
Registered in v-safe
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2021-01-09
Dose 1 — Moderna
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2021-01-09
Health check-in — day 0, dose 1Feeling: Good · Site: Pain, Itching · Fatigue or tirednessAdult check-in
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2021-01-10
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-01-11
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-01-12
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Redness, Swelling, Itching · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-01-13
- 2021-01-14
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2021-01-23
Survey response — day 14, dose 1MedDRA: Induration, Lymph node pain, Lymphadenopathy, Vaccination site erythema, Vaccination site induration, Vaccination site pruritus, Vaccination site rash, Vaccination site warmth — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: On day 7 after vaccination I woke up with a new red, hard, rash at the vaccination site. It was very hot to the touch and extremely itchy. I also noticed swolken lymph nodes near my left under arm area that are hardened and painfulMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-23
Report sent to call center — day 14, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-01-30
- 2021-02-06
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2021-02-07
Dose 2 — Moderna
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2021-02-14
Health check-in — day 7, dose 2Feeling: Fair · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
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2021-02-21
Survey response — day 14, dose 2MedDRA: Chills, Fatigue, Migraine — Feeling: Fair · Be unable to work, Be unable to do your normal daily activitiesFree text: Had chills and migraine headache. Also moderate fatigue about 2 days poat 2nd vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-28
- 2021-03-07
- 2021-03-14
- 2021-03-21
- 2021-04-01
- 2021-05-09
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2021-08-10
Survey response — 6 months, dose 2MedDRA: Influenza like illness, Sinusitis — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Sinus infection and some flu like symptomMedDRA releases: 2021-09,2024-11 · check-in free text available
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2022-02-07
Survey response — 12 months, dose 2MedDRA: Office visit, Pregnancy — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Pregnancy · Healthcare visit (other): Check up with OBGYNMedDRA releases: 2024-11 · check-in free text available
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2022-02-07
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2022-02-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-09 | Moderna | |
| 2 | 2021-02-07 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-01-23 | Unsuccessful | |
| 2022-02-07 | Unsuccessful |
Free text
Release 2 — day 14, dose 1
Symptoms: On day 7 after vaccination I woke up with a new red, hard, rash at the vaccination site. It was very hot to the touch and extremely itchy. I also noticed swolken lymph nodes near my left under arm area that are hardened and painful
Release 4 — day 14, dose 2
Symptoms: Had chills and migraine headache. Also moderate fatigue about 2 days poat 2nd vaccine
Release 9 — 6 months, dose 2
Symptoms: Sinus infection and some flu like symptom
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 | Office visit | · | · | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Induration | ✓ | ✓ | ✓ |
| SD | Influenza like illness | ✓ | · | ✓ |
| SD | Lymph node pain | ✓ | ✓ | ✓ |
| SD | Lymphadenopathy | ✓ | ✓ | ✓ |
| SD | Migraine | ✓ | ✓ | ✓ |
| SD | Pregnancy | · | · | ✓ |
| SD | Sinusitis | ✓ | · | ✓ |
| SD | Vaccination site erythema | ✓ | ✓ | ✓ |
| SD | Vaccination site induration | ✓ | ✓ | ✓ |
| SD | Vaccination site pruritus | ✓ | ✓ | ✓ |
| SD | Vaccination site rash | ✓ | ✓ | ✓ |
| SD | Vaccination site warmth | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release