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XN8-29835-60646

3 vaccinations 4 coded responses 39 check-ins 4 free-text entries 1 call case
Sex
Female
Age at first dose
36-40
ZIP prefix
081 / NJ
Registered
2020-12-29
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino
Registered dependents
ANL-60279-15273 Child or adolescent in my care · Male · 2022-06-22
4Z7-21971-02367 Child or adolescent in my care · Female · 2022-06-22

Timeline

  1. 2020-12-29
    Registered in v-safe
  2. 2020-12-29
    Dose 1 — Moderna
  3. 2020-12-29
    Health check-in — day 0, dose 1
    Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness
    Adult check-in
  4. 2020-12-30
    Survey response — days 1–6 daily, dose 1
    MedDRA: Ventricular extrasystoles — Feeling: Good · Site: Pain · Fatigue or tiredness
    Free text: Was having PVCs yesterday
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2020-12-31
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-01-01
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-01-03
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-01-04
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-01-05
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-01-12
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-01-19
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-01-25
    Dose 2 — Moderna
  13. 2021-01-25
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-01-26
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · Headache, Muscle or body aches
    Adult check-in
  15. 2021-01-27
    Survey response — days 1–6 daily, dose 2
    MedDRA: Abdominal pain, Pelvic pain — Feeling: Good · Site: Pain · Muscle or body aches, Abdominal pain
    Free text: These symptoms were in evening/overnight. Resolved now. Abdominal pain felt almost like menstrual cramps and pelvic pain (which I do not get as I have an IUD)
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-01-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-01-29
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-01-30
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-01-31
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-02-01
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-02-08
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-02-15
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-02-22
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-03-01
    Survey response — day 35, dose 2
    MedDRA: Oropharyngeal pain — Feeling: Good
    Free text: Sore throat
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  25. 2021-03-08
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-04-26
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-07-26
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-11-08
    Dose 3 — Moderna
  29. 2021-11-09
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness
    Adult check-in
  30. 2021-11-10
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  31. 2021-11-11
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  32. 2021-11-12
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  33. 2021-11-13
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  34. 2021-11-14
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  35. 2021-11-15
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  36. 2021-11-22
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  37. 2021-11-29
    Survey response — day 21, dose 3
    MedDRA: Oropharyngeal pain, Pain, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Sore throat, body aches - 2 rapid and 1 PCR all negative for covid
    MedDRA releases: 2024-11 · check-in free text available
  38. 2021-11-29
    Report sent to call center — day 21, dose 3
    Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  39. 2021-11-30
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  40. 2021-12-06
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  41. 2021-12-13
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  42. 2021-12-20
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  43. 2022-02-07
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  44. 2022-05-09
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  45. 2022-11-08
    Health check-in — 12 months, dose 3
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12020-12-29Moderna
22021-01-25Moderna
32021-11-08Moderna No

Call center

ReportedOutcomeVAERS-related outcome
2021-11-29 Successful
2021-11-30
 Not applicable (accidental reporting or does not believe symptoms are related to vaccine)

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-30

Systemic reaction (other): Was having PVCs yesterday

Release 2 — days 1–6 daily, dose 2

2021-01-27

Systemic reaction (other): These symptoms were in evening/overnight. Resolved now. Abdominal pain felt almost like menstrual cramps and pelvic pain (which I do not get as I have an IUD)

Release 4 — day 35, dose 2

2021-03-01

Symptoms: Sore throat

Release 10 — day 21, dose 3

2021-11-29

Symptoms: Sore throat, body aches - 2 rapid and 1 PCR all negative for covid

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

FieldPreferred term2021-092023-042024-11
SDOropharyngeal pain ✓ ✓ ✓
SDPain · · ✓
SDSARS-CoV-2 test negative · · ✓
SROAbdominal pain ✓ ✓ ✓
SROPelvic pain ✓ ✓ ✓
SROVentricular extrasystoles ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release

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