XUR-14834-42042
5 vaccinations
10 coded responses
53 check-ins
10 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 51-55
- ZIP prefix
- 100 / NY
- Registered
- 2021-01-13
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-13
Registered in v-safe
-
2021-01-13
Dose 1 — Moderna
-
2021-01-13
Health check-in — 0 day, dose 1Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-01-13
Report sent to call center — 0 day, dose 1Be unable to do your normal daily activities1 call case(s)
-
2021-01-14
Survey response — days 1–6 daily, dose 1MedDRA: Injected limb mobility decreased, Injection site pain — Feeling: Good · Site: Pain · Muscle or body achesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-01-15
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2021-01-16
Survey response — days 1–6 daily, dose 1MedDRA: Myalgia — Feeling: Good · Site: Pain · Muscle or body achesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-01-17
-
2021-01-19
Survey response — days 1–6 daily, dose 1MedDRA: Pre-existing disease, Pruritus — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-01-20
Survey response — 7 day, dose 1MedDRA: Pruritus — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-01-27
-
2021-02-03
Survey response — 21 day, dose 1MedDRA: Rhinorrhoea — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-10
-
2021-02-14
Dose 2 — Moderna
-
2021-02-15
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-02-17
-
2021-02-18
Survey response — days 1–6 daily, dose 2MedDRA: Incorrect route of product administration — Feeling: Good · Site: PainMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-21
Survey response — 7 day, dose 2MedDRA: Unevaluable event — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-28
- 2021-03-08
- 2021-03-14
- 2021-03-22
- 2021-03-28
- 2021-05-23
- 2021-08-15
-
2021-10-28
Dose 3 — ModernaCo-administered: yes
- 2021-10-28
-
2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-10-31
- 2021-11-01
-
2021-11-02
Survey response — days 1–6 daily, dose 3MedDRA: Dry mouth, Dry skin — Feeling: Good · Site: PainMedDRA releases: 2024-11 · check-in answers available
- 2021-11-03
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2021-11-04
Health check-in — 7 day, dose 3Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-11-12
- 2021-11-19
- 2021-11-25
- 2021-12-02
- 2021-12-10
- 2022-01-29
-
2022-04-28
Survey response — 6 month, dose 3MedDRA: Unevaluable event — Feeling: GoodMedDRA releases: 2024-11 · check-in answers available
-
2022-05-13
Dose 4 — Moderna
- 2022-05-19
- 2022-05-20
- 2022-05-27
- 2022-06-05
- 2022-06-10
- 2022-06-18
- 2022-06-24
- 2022-08-13
-
2022-11-10
Dose 5 — ModernaCo-administered: Flu
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2022-11-11
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-11-13
- 2022-11-15
- 2022-11-18
- 2022-11-24
- 2022-12-01
- 2022-12-09
- 2022-12-15
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2022-12-22
Survey response — 42 day, dose 5MedDRA: Rhinorrhoea — Feeling: FairMedDRA releases: 2024-11 · check-in answers available
- 2023-05-12
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-13 | Moderna | |
| 2 | 2021-02-14 | Moderna | |
| 3 | 2021-10-28 | Moderna | Yes |
| 4 | 2022-05-13 | Moderna | No |
| 5 | 2022-11-10 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-01-13 | priority 2/3 |
Free text
Release 1
Systemic reaction (other): Muscle pain at injection site, limits raising arm. Yesterday, too.
Release 2
Systemic reaction (other): Deltoid muscle is less sore; able to lift my arm more easily
Systemic reaction (other): I apologize that I should have disclosed this earlier: Itchy skin on forearms and anterior neck since Summer 2020. Was NOT exacerbated by the vaccine. I am taking generic Zyrtec daily starting 1/11/2021, and I am moisturizing my skin with relief.
Systemic reaction (other): Actually, what I reported yesterday, itchy skin on ventral forearms and anterior neck. What I reported yesterday, itchiness better with moisturizing.
Release 3
Symptoms: Runny nose
Release 4
Systemic reaction (other): Does it matter if the injection was not intramuscular?
Systemic reaction (other): Not sure I received an IM injection
Release 10
Systemic reaction (other): Dry mouth, dryness
Release 11
Symptoms: I had a colf
Release 12
Symptoms: Runny nose
Free-text releases are not linked to a specific 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 | Rhinorrhoea | ✓ | ✓ | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Dry mouth | · | · | ✓ |
| SRO | Dry skin | · | · | ✓ |
| SRO | Incorrect route of product administration | ✓ | ✓ | ✓ |
| SRO | Injected limb mobility decreased | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Myalgia | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release