V9C-11328-74576
5 vaccinations
4 coded responses
28 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 931 / CA
- Registered
- 2021-03-05
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-05
Registered in v-safe
-
2021-03-05
Dose 1 — Moderna
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-19
- 2021-03-26
-
2021-04-02
Dose 2 — Moderna
- 2021-04-02
-
2021-04-04
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-04-05
-
2021-04-06
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fever · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-04-07
- 2021-04-08
- 2021-04-10
-
2021-04-16
Survey response — day 14, dose 2MedDRA: Dizziness, Dyspnoea, Headache, Musculoskeletal discomfort, Sleep disorder — Feeling: GoodFree text: Hard to breathe, upper back felt constricted, headache, felt faint and like I was about to black out. This was waking up in bed in middle of night. Never felt this before. Went to recliner chair and soon fell back asleep. Later to bed, now ok.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-23
Survey response — day 21, dose 2MedDRA: Diarrhoea, Headache, Parosmia, Pre-existing disease — Feeling: GoodFree text: Diahhrea, headache. Also please note, last week's event occurred upon first night of new CPAP mask/hoses. Even after having washed them before using, I could smell the new plastic VOCs. (Heightened immune response to VOCs?) Hasn't happened again.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-30
- 2021-05-07
- 2021-05-15
- 2021-07-02
- 2021-10-01
-
2021-11-03
Dose 3 — Moderna
-
2022-04-08
Dose 4 — Moderna
-
2022-09-16
Dose 5 — Pfizer-BioNTech
-
2022-10-11
Survey response — day 21, dose 5MedDRA: Abdominal pain, Emergency care, Surgery, Uterine dilation and curettage, Uterine polyp, Vaginal haemorrhage, Vomiting — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationFree text: Symptoms: 11/09/2021 vomit, abdominal pain, went to ER 05/24/2022 vaginal bleeding several days, received a D&C for uterine polyps · Healthcare visit (other): Outpatient surgery in OR at hospitalMedDRA releases: 2024-11 · check-in free text available
-
2022-10-11
Report sent to call center — day 21, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-10-12
-
2022-10-13
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-10-21
Survey response — day 35, dose 5MedDRA: Lymph node pain, Lymphadenopathy — Feeling: GoodFree text: After 9/16/22 pfizer bivalent booster in right arm, had a small tender swollen lymph gland near right collarbone, days 3-5 after the shot. (Self-diagnosed with Google search.)MedDRA releases: 2024-11 · check-in free text available
- 2022-10-28
- 2022-12-16
- 2023-03-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-05 | Moderna | |
| 2 | 2021-04-02 | Moderna | |
| 3 | 2021-11-03 | Moderna | No |
| 4 | 2022-04-08 | Moderna | No |
| 5 | 2022-09-16 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-11 | Successful 2022-10-13 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 7 — day 14, dose 2
Symptoms: Hard to breathe, upper back felt constricted, headache, felt faint and like I was about to black out. This was waking up in bed in middle of night. Never felt this before. Went to recliner chair and soon fell back asleep. Later to bed, now ok.
Release 7 — day 21, dose 2
Symptoms: Diahhrea, headache. Also please note, last week's event occurred upon first night of new CPAP mask/hoses. Even after having washed them before using, I could smell the new plastic VOCs. (Heightened immune response to VOCs?) Hasn't happened again. cut off by CDC
Release 12 — day 21, dose 5
Symptoms: 11/09/2021 vomit, abdominal pain, went to ER 05/24/2022 vaginal bleeding several days, received a D&C for uterine polyps
Healthcare visit (other): Outpatient surgery in OR at hospital
Release 12 — day 35, dose 5
Symptoms: After 9/16/22 pfizer bivalent booster in right arm, had a small tender swollen lymph gland near right collarbone, days 3-5 after the shot. (Self-diagnosed with Google search.)
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 | Surgery | · | · | ✓ |
| SD | Abdominal pain | · | · | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Lymph node pain | · | · | ✓ |
| SD | Lymphadenopathy | · | · | ✓ |
| SD | Musculoskeletal discomfort | ✓ | ✓ | ✓ |
| SD | Parosmia | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Sleep disorder | ✓ | ✓ | ✓ |
| SD | Uterine dilation and curettage | · | · | ✓ |
| SD | Uterine polyp | · | · | ✓ |
| SD | Vaginal haemorrhage | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release