Y4J-20475-66460
5 vaccinations
5 coded responses
58 check-ins
5 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 440 / OH
- Registered
- 2021-01-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-15
Registered in v-safe
-
2021-01-15
Dose 1 — Moderna
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-20
- 2021-01-21
- 2021-01-22
- 2021-01-29
- 2021-02-05
-
2021-02-12
Dose 2 — Moderna
- 2021-02-12
-
2021-02-13
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
- 2021-02-14
- 2021-02-15
-
2021-02-16
Survey response — days 1–6 daily, dose 2MedDRA: Nasal congestion, Throat irritation — Feeling: GoodFree text: Mild scratchy throat, mild nasal congestion.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-26
- 2021-03-05
- 2021-03-12
- 2021-03-19
- 2021-03-26
- 2021-05-15
- 2021-08-13
-
2021-11-27
Dose 3 — Pfizer-BioNTech
-
2021-12-28
Survey response — day 28, dose 3MedDRA: Emergency care, Pre-existing disease, Pulmonary embolism — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Booster on 11/27/21. Pulmonary embolism diagnosed in ER on 12/1/21. However, had had orthopedic surgery on 10/11/21.MedDRA releases: 2024-11 · check-in free text available
-
2021-12-28
Report sent to call center — day 28, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2021-12-29
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-01-01
- 2022-01-08
- 2022-02-26
-
2022-04-23
Dose 4 — Pfizer-BioNTech
- 2022-04-23
-
2022-04-24
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Joint pains, Muscle or body achesAdult check-in
- 2022-04-25
- 2022-04-26
- 2022-04-27
-
2022-04-28
Survey response — days 1–6 daily, dose 4MedDRA: Erythema, Pruritus, Skin lesion, Tenderness, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): One round, 1 cm diameter very red itching and tender lesion noted yesterday, new since skin check by dermatologist 2 weeks ago. Appears as a herpes lesion. It is under my left breast. · Healthcare visit (other): Have appt scheduled with dermatologist.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-28
Report sent to call center — days 1–6 daily, dose 4Get care from a doctor or other healthcare professional1 call case(s)
-
2022-04-29
Survey response — days 1–6 daily, dose 4MedDRA: Blister, Erythema, Pruritus, Rash, Skin lesion, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): 1 cm flat red blistered itching skin lesion that erupted on 4/26 is still present. · Healthcare visit (other): Dermatology appt is scheduled for May 18.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-29
Report sent to call center — days 1–6 daily, dose 4Get care from a doctor or other healthcare professional1 call case(s)
-
2022-04-29
Call successfulCompleted over the phone
-
2022-04-30
Survey response — day 7, dose 4MedDRA: Erythema — Feeling: GoodFree text: Small red area below left breast previously reported still there.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-07
- 2022-05-14
- 2022-05-21
- 2022-05-28
- 2022-06-04
- 2022-07-23
-
2022-09-24
Dose 5 — Pfizer-BioNTech
- 2022-09-24
- 2022-09-25
- 2022-09-26
- 2022-09-27
- 2022-09-28
- 2022-09-29
- 2022-09-30
- 2022-10-01
- 2022-10-08
- 2022-10-16
- 2022-10-22
- 2022-10-29
- 2022-11-05
- 2022-12-24
- 2023-03-25
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-15 | Moderna | |
| 2 | 2021-02-12 | Moderna | |
| 3 | 2021-11-27 | Pfizer-BioNTech | No |
| 4 | 2022-04-23 | Pfizer-BioNTech | No |
| 5 | 2022-09-24 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-12-28 | Successful 2021-12-29 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-04-28 | Successful 2022-04-29 |
Completed over the phone |
| 2022-04-29 | Successful | Completed over the phone |
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Mild scratchy throat, mild nasal congestion.
Release 10 — day 28, dose 3
Symptoms: Booster on 11/27/21. Pulmonary embolism diagnosed in ER on 12/1/21. However, had had orthopedic surgery on 10/11/21.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): One round, 1 cm diameter very red itching and tender lesion noted yesterday, new since skin check by dermatologist 2 weeks ago. Appears as a herpes lesion. It is under my left breast.
Healthcare visit (other): Have appt scheduled with dermatologist.
Systemic reaction (other): 1 cm flat red blistered itching skin lesion that erupted on 4/26 is still present.
Healthcare visit (other): Dermatology appt is scheduled for May 18.
Release 11 — day 7, dose 4
Systemic reaction (other): Small red area below left breast previously reported still there.
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 | Emergency care | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pulmonary embolism | · | · | ✓ |
| SRO | Blister | · | · | ✓ |
| SRO | Erythema | · | · | ✓ |
| SRO | Nasal congestion | ✓ | ✓ | ✓ |
| SRO | Pruritus | · | · | ✓ |
| SRO | Rash | · | · | ✓ |
| SRO | Skin lesion | · | · | ✓ |
| SRO | Tenderness | · | · | ✓ |
| SRO | Throat irritation | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release