Y39-10727-14618
2 vaccinations
5 coded responses
26 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 190 / PA
- Registered
- 2021-03-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-09
Registered in v-safe
-
2021-03-09
Dose 1 — Moderna
- 2021-03-09
- 2021-03-10
-
2021-03-11
Survey response — days 1–6 daily, dose 1MedDRA: Dizziness — Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tirednessFree text: DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-12
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Itching · Fatigue or tirednessAdult check-in
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-16
-
2021-03-23
Survey response — day 14, dose 1MedDRA: Immunisation reaction, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling — Feeling: GoodFree text: On the eighth day after my shot I experienced Covid Arm. Extremely itchy rash on about 5 inch circle around injection sight, and a painful golf-ball sized swelling under the sight. Lasted about 1 1/2 days.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-30
-
2021-04-06
Dose 2 — Moderna
- 2021-04-06
-
2021-04-07
Survey response — days 1–6 daily, dose 2MedDRA: Medical counselling — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: PhysicianMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-07
Report sent to call center — days 1–6 daily, 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)
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2021-04-08
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work or attend school, Be unable to do your normal daily activitiesAdult check-in
-
2021-04-09
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling, Itching · Fever · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Good · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-04-11
- 2021-04-12
- 2021-04-13
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2021-04-22
Survey response — day 14, dose 2MedDRA: Injection site pruritus, Pruritus — Feeling: GoodFree text: Itchy arms st both injection sitesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-27
- 2021-05-04
- 2021-05-11
- 2021-05-18
- 2021-07-06
- 2021-10-09
- 2021-12-21
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2022-04-08
Survey response — 12 months, dose 2MedDRA: Influenza like illness, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: I have had two bouts of flu or Covid- like symptoms in the past 3 months but did not test positive for Covid. Don't know if that counts as anything but thought it worth mentioning.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-09 | Moderna | |
| 2 | 2021-04-06 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-07 | Unsuccessful |
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Dizziness
Release 6 — day 14, dose 1
Symptoms: On the eighth day after my shot I experienced Covid Arm. Extremely itchy rash on about 5 inch circle around injection sight, and a painful golf-ball sized swelling under the sight. Lasted about 1 1/2 days.
Release 7 — days 1–6 daily, dose 2
Healthcare visit (other): Physician
Release 7 — day 14, dose 2
Symptoms: Itchy arms st both injection sites
Release 11 — 12 months, dose 2
Symptoms: I have had two bouts of flu or Covid- like symptoms in the past 3 months but did not test positive for Covid. Don't know if that counts as anything but thought it worth mentioning.
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 | Medical counselling | ✓ | ✓ | ✓ |
| SD | Immunisation reaction | ✓ | ✓ | ✓ |
| SD | Influenza like illness | · | · | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SD | Injection site swelling | ✓ | ✓ | ✓ |
| SD | Pruritus | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release