W95-12066-44729
3 vaccinations
3 coded responses
16 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 802 / CO
- Registered
- 2021-08-11
- Relationship
- Self
- Race
- N/A
- Ethnicity
- Hispanic or Latino
Registered dependents
5T7-21653-39061
Child or adolescent in my care · Male · 2021-08-11
AQP-11818-02885
Child or adolescent in my care · Female · 2021-12-20
FSJ-30634-29935
Child or adolescent in my care · Male · 2021-12-20
Timeline
-
2021-04-11
Dose 1 — Moderna
-
2021-05-08
Dose 2 — Moderna
-
2021-08-11
Registered in v-safe
- 2021-08-11
- 2021-11-06
-
2021-12-19
Dose 3 — ModernaCo-administered: Flu
-
2021-12-20
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-12-21
Survey response — days 1–6 daily, dose 3MedDRA: Pain, Respiratory tract congestion — Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend schoolFree text: Congestion painMedDRA releases: 2024-11 · check-in free text available
- 2021-12-22
-
2021-12-23
Health check-in — days 1–6 daily, dose 3Feeling: Good · Headache, Fatigue or tirednessAdult check-in
-
2021-12-24
Survey response — days 1–6 daily, dose 3MedDRA: Pain — Feeling: Good · Headache, Fatigue or tirednessFree text: Thought painMedDRA releases: 2024-11 · check-in free text available
- 2021-12-26
- 2022-01-02
- 2022-01-09
- 2022-01-17
- 2022-01-23
- 2022-01-30
-
2022-03-20
Survey response — 3 months, dose 3MedDRA: Anxiety, Hypertension — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: High blood pressure, anxietyMedDRA releases: 2024-11 · check-in free text available
-
2022-03-20
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-03-23
- 2022-06-19
- 2022-12-19
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-11 | Moderna | No |
| 2 | 2021-05-08 | Moderna | No |
| 3 | 2021-12-19 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-03-20 | Unsuccessful |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Congestion pain
Systemic reaction (other): Thought pain
Release 11 — 3 months, dose 3
Symptoms: High blood pressure, anxiety
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 | Anxiety | · | · | ✓ |
| SD | Hypertension | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Respiratory tract congestion | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release