XZE-57815-03385
5 vaccinations
10 coded responses
67 check-ins
10 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 967 / HI
- Registered
- 2021-01-28
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Registered dependents
5RN-32153-20869
Adult relative or friend · Female · 2021-09-08
YQ6-28843-11154
Adult relative or friend · Female · 2021-09-08
76L-13522-85427
Adult relative or friend · Male · 2022-10-07
Timeline
-
2021-01-28
Registered in v-safe
-
2021-01-28
Dose 1 — Moderna
- 2021-01-28
- 2021-01-29
- 2021-01-30
-
2021-01-31
Survey response — days 1–6 daily, dose 1MedDRA: Erythema, Pruritus — Feeling: Good · Site: Redness, Itching · Muscle or body achesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-01
- 2021-02-02
-
2021-02-03
Health check-in — days 1–6 daily, dose 1Feeling: Good · Joint pains, Muscle or body achesAdult check-in
- 2021-02-04
-
2021-02-11
Survey response — 14 day, dose 1MedDRA: Injection site pruritus — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-18
-
2021-02-25
Dose 2 — Moderna
-
2021-02-25
Health check-in — 0 day, dose 2Feeling: Good · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body achesAdult check-in
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2021-02-26
Survey response — days 1–6 daily, dose 2MedDRA: Myalgia — Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body achesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-27
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Myalgia, Sleep disorder — Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tirednessMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-28
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Swelling · Muscle or body achesAdult check-in
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
-
2021-03-11
Survey response — 14 day, dose 2MedDRA: Dizziness, Headache, Muscle strain — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-03-18
Survey response — 21 day, dose 2MedDRA: Chills, Hypoaesthesia — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-03-25
-
2021-04-01
Survey response — 35 day, dose 2MedDRA: Chills, Hypoaesthesia — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-04-08
-
2021-05-27
Survey response — 3 month, dose 2MedDRA: Hypoaesthesia, Visual impairment — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-08-26
Survey response — 6 month, dose 2MedDRA: Chest pain, Massage, Neck pain, Oropharyngeal pain — Feeling: Good · Get care from a doctor or other healthcare professionalMedDRA releases: 2021-09,2024-11 · check-in answers available
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2021-08-26
Report sent to call center — 6 month, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-02
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2021-09-02
Callback requested for6:00PM ET
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2021-09-02
Call successfulDoes not wish to fill out VAERS report
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2021-11-05
Dose 3 — Moderna
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2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-11-07
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Joint pains, Muscle or body achesAdult check-in
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2021-11-08
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Itching · Joint pains, Fatigue or tiredness, DiarrheaAdult check-in
- 2021-11-09
- 2021-11-10
- 2021-11-11
- 2021-11-12
- 2021-11-19
- 2021-11-27
- 2021-12-03
- 2021-12-10
- 2021-12-17
-
2022-02-04
Survey response — 3 month, dose 3MedDRA: Arthralgia, Headache — Feeling: GoodMedDRA releases: 2024-11 · check-in answers available
-
2022-06-03
Dose 4 — Moderna
- 2022-06-03
-
2022-06-04
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-06-05
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Itching · Joint pains, Muscle or body achesAdult check-in
- 2022-06-06
-
2022-06-07
Health check-in — days 1–6 daily, dose 4Feeling: Good · Joint pains, Muscle or body achesAdult check-in
-
2022-06-08
Health check-in — days 1–6 daily, dose 4Feeling: Good · Headache, Joint pains, Muscle or body achesAdult check-in
- 2022-06-09
- 2022-06-10
- 2022-06-17
- 2022-06-24
- 2022-07-01
- 2022-07-08
- 2022-07-17
- 2022-09-02
-
2022-10-07
Dose 5 — Moderna
- 2022-10-07
-
2022-10-08
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain, Itching · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-10-09
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain, Itching · Joint pains, Muscle or body achesAdult check-in
-
2022-10-10
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain, Itching · Joint painsAdult check-in
-
2022-10-11
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain, Itching · Headache, Joint painsAdult check-in
- 2022-10-12
- 2022-10-13
- 2022-10-15
- 2022-10-22
- 2022-10-29
- 2022-11-04
- 2022-11-11
- 2022-11-18
- 2023-01-08
- 2023-04-07
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-28 | Moderna | |
| 2 | 2021-02-25 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-06-03 | Moderna | No |
| 5 | 2022-10-07 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-08-26 | Successful 2021-09-02 |
Does not wish to fill out VAERS report |
Free text
Release 3
Systemic reaction (other): When I removed de Band-Aid yesterday thats when the itching and redness that I noticed.
Release 4
Symptoms: Itching below the area where shot was received
Systemic reaction (other): Muscle pain affecting my right side of neck
Systemic reaction (other): Muscle and joint pain kept me up for 2-nights
Release 5
Symptoms: Slight headache; neck muscle strain and dizziness
Symptoms: Chills and slight numbness on the right and left-side of head. Started on the right then gravitated to the left-side. Lasted about three hours then dissipated.Ive had these reactions after 4-days of the second vaccination and failed to report it
Release 6
Symptoms: For today theres a slight numbing on left side of head.Yesterday, I had chills that lasted several hours.
Release 8
Symptoms: Occasional mild numbing sensation traveling from one side of my head to the other side. One week ago, while driving my vision displayed 4-lines of red lights organized in a square shape. I blinked three times to bring back my normal vision
Release 9
Symptoms: Sore throat and neck pain; occasional chest pain.
Healthcare visit (other): Taken 25mcg zinc and immunity booster. Applied moist heat on neck. Seen a cranial sacral therapist for neck pain.
Release 11
Symptoms: Vague headaches and sore joints
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 |
|---|---|---|---|---|
| HCVO | Massage | ✓ | · | ✓ |
| HCVO | Neck pain | ✓ | · | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Chest pain | ✓ | · | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Hypoaesthesia | ✓ | ✓ | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Muscle strain | ✓ | ✓ | ✓ |
| SD | Neck pain | ✓ | · | ✓ |
| SD | Oropharyngeal pain | ✓ | · | ✓ |
| SD | Visual impairment | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Myalgia | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Sleep disorder | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release