XXJ-28825-53199
2 vaccinations
5 coded responses
12 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 325 / FL
- Registered
- 2021-04-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-06
Dose 1 — Moderna
-
2021-04-13
Registered in v-safe
-
2021-04-13
Health check-in — 7 day, dose 1Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Fatigue or tirednessAdult check-in
-
2021-04-21
Survey response — 14 day, dose 1MedDRA: Arthralgia, Immunisation reaction, Myalgia, Neck pain, Rash — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-04-27
Survey response — 21 day, dose 1MedDRA: Fatigue, Nausea, Pyrexia — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-04-27
Report sent to call center — 21 day, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-05-04
Dose 2 — Moderna
-
2021-05-06
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Good · Site: Pain · Muscle or body achesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-05-08
Health check-in — days 1–6 daily, dose 2Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-05-13
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2021-05-19
Survey response — 14 day, dose 2MedDRA: Dizziness, Dysgeusia, Lymph node pain, Noninfective gingivitis, Pain in jaw, Tinnitus, Vaccine positive rechallenge — Feeling: Fair · Be unable to do your normal daily activitiesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-05-27
- 2021-06-01
-
2021-06-08
Survey response — 35 day, dose 2MedDRA: Nasopharyngitis — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-06-15
- 2021-08-05
- 2022-04-07
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-06 | Moderna | |
| 2 | 2021-05-04 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-27 | Unsuccessful |
Free text
Release 7
Symptoms: Today, two weeks after my first dose, muscle soreness returned in my shoulder and neck (same side as where I had the shot and same distinct ache). Mild but odd timing, one week after covid arm rash
Release 8
Symptoms: Since vaccination 3 weeks ago, Ive had episodes that come & go every few days and feel like my blood sugar is crashing (Im not diabetic) lightheaded, ears ringing, dizzy, bad anxiety/feelings of despair, nausea, ache near injection site, fa
Systemic reaction (other): Occasional dizziness/lightheadedness
Symptoms: Left lymph node (same side as injection site) tender and causing jaw pain, inflammation of gums, dizzy spell, briefly experienced metallic taste, briefly experienced ears ringing during dizzy spell (similar symptoms as two weeks after 1st shot)
Symptoms: Caught a summer cold
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 | Arthralgia | ✓ | ✓ | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Dysgeusia | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Immunisation reaction | ✓ | ✓ | ✓ |
| SD | Lymph node pain | ✓ | ✓ | ✓ |
| SD | Myalgia | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SD | Neck pain | ✓ | ✓ | ✓ |
| SD | Noninfective gingivitis | ✓ | ✓ | ✓ |
| SD | Pain in jaw | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Tinnitus | ✓ | ✓ | ✓ |
| SD | Vaccine positive rechallenge | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release