XWW-15844-09368
5 vaccinations
7 coded responses
64 check-ins
7 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 734 / OK
- Registered
- 2020-12-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-27
Dose 1 — Moderna
-
2020-12-28
Registered in v-safe
- 2020-12-28
- 2020-12-29
- 2020-12-30
- 2020-12-31
-
2021-01-01
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Good · DiarrheaMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-01-02
- 2021-01-03
- 2021-01-17
-
2021-01-24
Dose 2 — Moderna
-
2021-01-25
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Itching · Fever · Headache, Fatigue or tirednessAdult check-in
-
2021-01-26
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Itching · DiarrheaAdult check-in
-
2021-01-27
Survey response — days 1–6 daily, dose 2MedDRA: Self-medication, Urticaria — Feeling: Good · Site: Redness, Swelling, Itching · Rash, not including the immediate area around the injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-01-28
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-07
-
2021-02-14
Survey response — 21 day, dose 2MedDRA: Abdominal pain — Feeling: Poor · Be unable to do your normal daily activitiesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-21
Survey response — 28 day, dose 2MedDRA: Diverticular perforation, Diverticulitis, Hospitalisation — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-21
Report sent to call center — 28 day, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-28
- 2021-03-07
- 2021-04-25
- 2021-07-25
- 2021-08-17
-
2021-11-03
Dose 3 — Moderna
-
2021-11-04
Survey response — days 1–6 daily, dose 3MedDRA: Injection site warmth — Feeling: Good · Site: PainMedDRA releases: 2024-11 · check-in answers available
- 2021-11-05
-
2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Swelling, Itching · NoneAdult check-in
- 2021-11-07
- 2021-11-08
- 2021-11-09
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2021-12-15
-
2022-02-02
Survey response — 3 month, dose 3MedDRA: COVID-19, Sinusitis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11 · check-in answers available
-
2022-02-02
Report sent to call center — 3 month, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-02-03
- 2022-05-04
-
2022-06-03
Dose 4 — Moderna
- 2022-06-03
-
2022-06-04
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Itching · Joint pains, Fatigue or tirednessAdult check-in
-
2022-06-05
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Fatigue or tiredness, DiarrheaAdult check-in
- 2022-06-06
- 2022-06-07
- 2022-06-08
- 2022-06-09
- 2022-06-10
- 2022-06-17
-
2022-06-24
Survey response — 21 day, dose 4MedDRA: Abdominal pain upper, Chest pain — Feeling: Poor · Be unable to do your normal daily activitiesMedDRA releases: 2024-11 · check-in answers available
- 2022-07-01
- 2022-07-08
- 2022-07-15
- 2022-09-02
-
2022-09-19
Dose 5 — Moderna
- 2022-09-19
- 2022-09-20
- 2022-09-21
- 2022-09-22
- 2022-09-23
- 2022-09-24
- 2022-09-25
- 2022-09-26
- 2022-10-03
- 2022-10-10
- 2022-10-18
- 2022-10-31
- 2022-12-19
- 2023-03-20
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-27 | Moderna | |
| 2 | 2021-01-24 | Moderna | |
| 3 | 2021-11-03 | Moderna | No |
| 4 | 2022-06-03 | Moderna | No |
| 5 | 2022-09-19 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-02-21 | Unsuccessful | |
| 2022-02-02 | Unsuccessful |
Free text
Release 1
Systemic reaction (other): '
Release 2
Systemic reaction (other): There are four hives on the arm of injection below the vaccine site and one large one on the bicep. Took loratadine for it.
Release 4
Symptoms: Right side abdominal pain
Symptoms: I was hospitalized for diverticulitis with a small rupture. IV antibiotics for 3 days. Admitted on Feb 14th and discharged Feb 19th on a low residue diet.
Release 10
Systemic reaction (other): The injection site is hot.
Release 11
Symptoms: Sinus infection symptoms which was diagnosed as covid infectIion.
Release 12
Symptoms: Epigastric pain, generalized chest pain,
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 | Abdominal pain | ✓ | ✓ | ✓ |
| SD | Abdominal pain upper | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Diverticular perforation | ✓ | ✓ | ✓ |
| SD | Diverticulitis | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SRO | Injection site warmth | · | · | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
| SRO | Urticaria | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release