XPJ-20166-59382
3 vaccinations
2 coded responses
12 check-ins
2 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 36-40
- ZIP prefix
- 921 / CA
- Registered
- 2021-01-15
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-14
Dose 1 — Moderna
-
2021-01-15
Registered in v-safe
-
2021-01-15
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tiredness, NauseaAdult check-in
- 2021-01-17
- 2021-01-21
- 2021-01-28
- 2021-02-06
-
2021-02-12
Dose 2 — Moderna
- 2021-02-26
- 2021-03-07
- 2021-03-14
- 2021-03-26
- 2021-05-14
-
2021-11-16
Dose 3 — Moderna
-
2022-02-12
Survey response — 12 months, dose 2MedDRA: Memory impairment — Feeling: GoodFree text: Short term memory troubleMedDRA releases: 2024-11 · check-in free text available
-
2022-05-18
Survey response — 6 months, dose 3MedDRA: Placental insufficiency, Pre-eclampsia — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationFree text: Preeclampsia, placenta not working properlyMedDRA releases: 2024-11 · check-in free text available
-
2022-05-18
Report sent to call center — 6 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prHospitalization · 1 call case(s)
-
2022-05-19
Call successfulNot applicable - Accidental Reporting
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-14 | Moderna | |
| 2 | 2021-02-12 | Moderna | |
| 3 | 2021-11-16 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-05-18 | Successful 2022-05-19 |
Not applicable - Accidental Reporting |
Free text
Release 11 — 12 months, dose 2
Symptoms: Short term memory trouble
Release 11 — 6 months, dose 3
Symptoms: Preeclampsia, placenta not working properly
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 | Memory impairment | · | · | ✓ |
| SD | Placental insufficiency | · | · | ✓ |
| SD | Pre-eclampsia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release