X36-23477-86050
1 vaccination
1 coded response
1 check-in
1 free-text entry
0 call cases
- Sex
- Female
- Age at first dose
- 16-20
- ZIP prefix
- 017 / MA
- Registered
- 2021-05-13
- Relationship
- Self
- Race
- White
- Ethnicity
- N/A
Timeline
-
2021-05-12
Dose 1 — Moderna
-
2021-05-13
Registered in v-safe
-
2021-05-13
Survey response — days 1–6 daily, dose 1MedDRA: Amnesia — Feeling: Poor · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Short term memory lossMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-05-12 | Moderna |
Free text
Release 8 — days 1–6 daily, dose 1
Systemic reaction (other): Short term memory loss
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 |
|---|---|---|---|---|
| SRO | Amnesia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release