Y29-31615-93928
2 vaccinations
4 coded responses
8 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 840 / UT
- Registered
- 2021-03-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-06
Dose 1 — Moderna
-
2021-03-06
Dose 2 — Moderna
-
2021-03-21
Registered in v-safe
- 2021-03-21
-
2021-03-28
Survey response — day 21, dose 2MedDRA: Cough, Nasal congestion, Pain, Pyrexia, Rash, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Fever, chest and nasal congestion, body aches, mild cough, and still have small rash on left arm and trunk of body from after vaccination.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-04
-
2021-04-10
Survey response — day 35, dose 2MedDRA: Rash, Rash erythematous — Feeling: FairFree text: I keep developing a splotchy rash that fades, and then flares up on my left arm and chest area since the vaccine. It just never fully goes away and this morning flared up quite a bit with visible quarter size red patches and some bumps.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-17
Survey response — day 42, dose 2MedDRA: Blepharospasm, Injection site reaction, Rash, Rash macular, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: I have had a left eye spasm that closes my eyelid several times a day. This is a strange thing Ive never had before the last few weeks but coincides with splotchy rash that comes & goes from the injection site on my left arm and across my chest. · Healthcare visit (other): Have appointment scheduled for this weekMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-17
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-05
- 2021-09-04
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2022-03-07
Survey response — 12 months, dose 2MedDRA: Malaise, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: I was I'll from Dec 26-Jan 31st with Covid like symptoms, however I tested 4 different times and was negative even though my husband tested positive with the same symptoms.MedDRA releases: 2024-11 · check-in free text available
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2022-03-07
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-03-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-06 | Moderna | |
| 2 | 2021-03-06 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-17 | Unsuccessful | |
| 2022-03-07 | Unsuccessful |
Free text
Release 6 — day 21, dose 2
Symptoms: Fever, chest and nasal congestion, body aches, mild cough, and still have small rash on left arm and trunk of body from after vaccination.
Release 7 — day 35, dose 2
Symptoms: I keep developing a splotchy rash that fades, and then flares up on my left arm and chest area since the vaccine. It just never fully goes away and this morning flared up quite a bit with visible quarter size red patches and some bumps.
Release 7 — day 42, dose 2
Symptoms: I have had a left eye spasm that closes my eyelid several times a day. This is a strange thing Ive never had before the last few weeks but coincides with splotchy rash that comes & goes from the injection site on my left arm and across my chest.
Healthcare visit (other): Have appointment scheduled for this week
Release 11 — 12 months, dose 2
Symptoms: I was I'll from Dec 26-Jan 31st with Covid like symptoms, however I tested 4 different times and was negative even though my husband tested positive with the same symptoms.
Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that 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 | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Blepharospasm | ✓ | ✓ | ✓ |
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Injection site reaction | ✓ | ✓ | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Nasal congestion | ✓ | ✓ | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Rash erythematous | ✓ | ✓ | ✓ |
| SD | Rash macular | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release