Y93-20571-91624
2 vaccinations
2 coded responses
22 check-ins
2 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 119 / NY
- Registered
- 2021-02-25
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-02-25
Registered in v-safe
-
2021-02-25
Dose 1 — Moderna
- 2021-02-25
- 2021-02-26
-
2021-02-27
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
-
2021-02-28
Survey response — days 1–6 daily, dose 1MedDRA: Injection site bruising, Injection site erythema, Injection site pain, Injection site swelling — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Just wanted to say that the injection site is only painful if touched, its not swollen anymore but although its not red anymore, it is black & blue, just like a healing bruiseMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-12
- 2021-03-19
-
2021-03-25
Dose 2 — Moderna
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-03-30
- 2021-03-31
- 2021-04-01
- 2021-04-12
-
2021-04-17
Survey response — day 21, dose 2MedDRA: Hospitalisation, Pyrexia, Urinary tract infection, Vomiting — Feeling: Fair · 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 visit, HospitalizationFree text: I was vomiting for 3 days, had a fever maximum of 101 & also developed a pretty severe urinary tract infection. Was admitted to hospital, however, due to below standard of care received I ultimately left ama i will f/u w/pcp dont think relatedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-17
Report sent to call center — day 21, 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)
- 2021-05-01
- 2021-05-09
- 2021-06-25
- 2021-09-25
- 2021-12-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-25 | Moderna | |
| 2 | 2021-03-25 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-17 | Unsuccessful |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Just wanted to say that the injection site is only painful if touched, its not swollen anymore but although its not red anymore, it is black & blue, just like a healing bruise
Release 7 — day 21, dose 2
Symptoms: I was vomiting for 3 days, had a fever maximum of 101 & also developed a pretty severe urinary tract infection. Was admitted to hospital, however, due to below standard of care received I ultimately left ama i will f/u w/pcp dont think related
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 |
|---|---|---|---|---|
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Urinary tract infection | ✓ | ✓ | ✓ |
| SD | Vomiting | ✓ | ✓ | ✓ |
| SRO | Injection site bruising | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Injection site swelling | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release