XY3-28030-36695
4 vaccinations
5 coded responses
21 check-ins
5 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 088 / NJ
- Registered
- 2021-01-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-07
Dose 1 — Moderna
-
2021-01-13
Registered in v-safe
- 2021-01-14
-
2021-01-21
Survey response — 14 day, dose 1MedDRA: Rash pruritic — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-01-28
-
2021-02-04
Dose 2 — Moderna
- 2021-02-04
-
2021-02-05
Survey response — days 1–6 daily, dose 2MedDRA: Pain — Feeling: Good · Site: PainMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-06
-
2021-02-07
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction, Sleep disorder — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · HeadacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-08
Survey response — days 1–6 daily, dose 2MedDRA: Pain, Pain in extremity, Self-medication — Feeling: Good · Site: Pain, Redness, ItchingMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-09
-
2021-02-10
Survey response — days 1–6 daily, dose 2MedDRA: Toothache — Feeling: Good · HeadacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-11
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-03-11
- 2021-03-19
- 2021-05-06
- 2021-08-05
-
2021-12-14
Dose 3 — Moderna
- 2022-02-04
-
2022-05-10
Dose 4 — Moderna
- 2022-08-09
- 2023-05-10
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-07 | Moderna | |
| 2 | 2021-02-04 | Moderna | |
| 3 | 2021-12-14 | Moderna | No |
| 4 | 2022-05-10 | Moderna | No |
Free text
Release 2
Symptoms: On day 9 I developed an itchy rash in a capsule shape about 4 long by 2 wide. Its went away in 2 1/2 days without incident or treatment. (Around injection site)
Release 3
Systemic reaction (other): Was aching during the night then it stopped in the morning
Systemic reaction (other): Symptoms are passing. Only mentioned it in case it was helpful. During night I couldnt sleep on that side. Its Improved
Systemic reaction (other): The arm pain included stinging .Improved with Tylenol.
Release 4
Systemic reaction (other): I believe it could be from a toothache Ive had off & on for a few days. Have appt on Friday
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 | Rash pruritic | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | · | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Sleep disorder | ✓ | ✓ | ✓ |
| SRO | Toothache | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release