UWW-18176-45570
4 vaccinations
5 coded responses
52 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 109 / NY
- Registered
- 2021-01-05
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
CSC-32723-00976
Child or adolescent in my care · Male · 2021-12-30
Timeline
-
2021-01-05
Registered in v-safe
-
2021-01-05
Dose 1 — Moderna
-
2021-01-05
Survey response — day 0, dose 1MedDRA: Migraine, Pre-existing disease — Feeling: Good · Site: PainFree text: Migraine, but I had one before the vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-06
- 2021-01-07
- 2021-01-08
-
2021-01-09
Survey response — days 1–6 daily, dose 1MedDRA: Ophthalmic migraine — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Ocular migraine (I've had them before)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-09
Report sent to call center — days 1–6 daily, dose 1Be unable to do your normal daily activities1 call case(s)
- 2021-01-12
- 2021-01-19
- 2021-01-26
-
2021-02-02
Dose 2 — Moderna
- 2021-02-02
-
2021-02-03
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness · Be unable to workAdult check-in
-
2021-02-04
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-16
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-05-04
- 2021-08-03
-
2021-12-30
Dose 3 — Moderna
- 2021-12-30
- 2021-12-31
-
2022-01-01
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
-
2022-01-02
Survey response — days 1–6 daily, dose 3MedDRA: Lymphadenopathy — Feeling: GoodFree text: Lymph nodes swollen under armpit in side of InjectionMedDRA releases: 2024-11 · check-in free text available
- 2022-01-03
- 2022-01-04
- 2022-01-05
- 2022-01-06
- 2022-01-13
- 2022-01-20
- 2022-01-27
- 2022-02-03
- 2022-02-12
- 2022-04-02
- 2022-06-30
-
2022-09-22
Dose 4 — Pfizer-BioNTechCo-administered: Flu
- 2022-09-23
- 2022-09-24
- 2022-09-25
- 2022-09-26
- 2022-09-27
- 2022-09-28
- 2022-09-29
- 2022-10-06
- 2022-10-15
- 2022-10-20
-
2022-10-27
Survey response — day 35, dose 4MedDRA: Abortion spontaneous — Feeling: Poor · Be unable to work or attend schoolFree text: MiscarriageMedDRA releases: 2024-11 · check-in free text available
-
2022-11-03
Survey response — day 42, dose 4MedDRA: Abortion spontaneous — Feeling: Poor · Be unable to work or attend schoolFree text: MiscarriageMedDRA releases: 2024-11 · check-in free text available
- 2022-12-22
- 2023-03-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-05 | Moderna | |
| 2 | 2021-02-02 | Moderna | |
| 3 | 2021-12-30 | Moderna | No |
| 4 | 2022-09-22 | Pfizer-BioNTech | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-01-09 | priority 2/3 |
Free text
Release 1 — day 0, dose 1
Systemic reaction (other): Migraine, but I had one before the vaccine
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Ocular migraine (I've had them before)
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Lymph nodes swollen under armpit in side of Injection
Release 12 — day 35, dose 4
Symptoms: Miscarriage
Release 12 — day 42, dose 4
Symptoms: Miscarriage
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 | Abortion spontaneous | · | · | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
| SRO | Migraine | ✓ | ✓ | ✓ |
| SRO | Ophthalmic migraine | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release