X6U-31761-68110
1 vaccination
1 coded response
2 check-ins
1 free-text entry
1 call case
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 037 / NH
- Registered
- 2021-05-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-30
Dose 1 — Moderna
-
2021-05-13
Registered in v-safe
-
2021-05-14
Survey response — day 14, dose 1MedDRA: Abortion spontaneous, Fatigue, Vaginal haemorrhage — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Severe fatigue 3 days starting 24 hrs after shot. Started spotting blood on Tuesday 5/4, 4 days after shot, had a miscarriage on Friday 5/7 at 11 weeks.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-14
Report sent to call center — day 14, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-23
- 2021-06-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-30 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-05-14 | Unsuccessful |
Free text
Release 8 — day 14, dose 1
Symptoms: Severe fatigue 3 days starting 24 hrs after shot. Started spotting blood on Tuesday 5/4, 4 days after shot, had a miscarriage on Friday 5/7 at 11 weeks.
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 | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Vaginal haemorrhage | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release