Y7Q-21299-67760
5 vaccinations
5 coded responses
63 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 087 / NJ
- Registered
- 2021-02-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-04
Registered in v-safe
-
2021-02-04
Dose 1 — Moderna
- 2021-02-04
- 2021-02-05
-
2021-02-06
Survey response — days 1–6 daily, dose 1MedDRA: Diarrhoea, Faeces soft — Feeling: GoodFree text: Not diarrhea but loose soft stools.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-18
- 2021-02-25
-
2021-03-04
Dose 2 — Moderna
- 2021-03-04
-
2021-03-05
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Fair · Site: Pain, Redness · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
- 2021-04-08
- 2021-04-15
- 2021-06-03
- 2021-09-02
-
2021-10-25
Dose 3 — Moderna
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Chills, Dizziness, Erythema, Fatigue, Headache, Hyperhidrosis, Injection site pain, Migraine, Pain, Swelling — Feeling: GoodFree text: I received my booster on Monday. I had site pain, redness & slight swelling Monday evening. Couldn't move my arm without significant pain. Monday night I had chills, sweats, dizziness & mild headache. Tuesday extremely tired & migraine headacheMedDRA releases: 2024-11 · check-in free text available
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
-
2021-11-08
Survey response — day 14, dose 3MedDRA: Dizziness, Headache — Feeling: GoodFree text: Mild Headache & some dizzinessMedDRA releases: 2024-11 · check-in free text available
- 2021-11-15
- 2021-11-22
-
2021-11-29
Survey response — day 35, dose 3MedDRA: Dizziness, Medical counselling — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Dizziness but I think it was due to a new medication and not the booster shot. · Healthcare visit (other): Phone call. Told to Stop new medicationMedDRA releases: 2024-11 · check-in free text available
-
2021-11-29
Report sent to call center — day 35, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-11-30
- 2021-12-06
-
2021-12-09
Call successfulDoes not wish to fill out VAERS report
- 2022-01-24
-
2022-04-22
Dose 4 — Moderna
-
2022-04-23
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
- 2022-04-24
- 2022-04-25
- 2022-04-26
- 2022-04-27
- 2022-04-28
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-06-03
- 2022-07-22
-
2022-10-13
Dose 5 — ModernaCo-administered: Flu
-
2022-10-14
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2022-10-15
- 2022-10-16
- 2022-10-17
- 2022-10-18
- 2022-10-19
- 2022-10-20
- 2022-10-27
- 2022-11-03
- 2022-11-10
- 2022-11-17
- 2022-11-24
- 2023-01-12
- 2023-04-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Moderna | |
| 2 | 2021-03-04 | Moderna | |
| 3 | 2021-10-25 | Moderna | No |
| 4 | 2022-04-22 | Moderna | No |
| 5 | 2022-10-13 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-11-29 | Successful 2021-12-09 |
Does not wish to fill out VAERS report |
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Not diarrhea but loose soft stools.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Dizziness
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): I received my booster on Monday. I had site pain, redness & slight swelling Monday evening. Couldn't move my arm without significant pain. Monday night I had chills, sweats, dizziness & mild headache. Tuesday extremely tired & migraine headache
Release 10 — day 14, dose 3
Symptoms: Mild Headache & some dizziness
Release 10 — day 35, dose 3
Symptoms: Dizziness but I think it was due to a new medication and not the booster shot.
Healthcare visit (other): Phone call. Told to Stop new medication
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 | Dizziness | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Diarrhoea | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Erythema | · | · | ✓ |
| SRO | Faeces soft | ✓ | ✓ | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Hyperhidrosis | · | · | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Migraine | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Swelling | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release