Y95-23127-63376
2 vaccinations
5 coded responses
14 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 902 / CA
- Registered
- 2021-02-05
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-05
Registered in v-safe
-
2021-02-05
Dose 1 — Moderna
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2021-02-05
Survey response — day 0, dose 1MedDRA: Anxiety, Dyspnoea — Feeling: Fair · Fatigue or tirednessFree text: shortness of breath, anxietyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-06
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
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2021-02-08
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Redness, Swelling · Abdominal painAdult check-in
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2021-02-10
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Redness, Swelling · Fatigue or tirednessAdult check-in
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2021-02-14
Health check-in — day 7, dose 1Feeling: Good · Site: Pain, Redness, Swelling · Diarrhea, Abdominal painAdult check-in
- 2021-02-21
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2021-03-05
Dose 2 — Moderna
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2021-03-12
Health check-in — day 7, dose 2Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-03-19
Survey response — day 14, dose 2MedDRA: Fatigue, Headache — Feeling: Fair · Be unable to do your normal daily activitiesFree text: extremely tired and headache every morning when i get up, then subsides.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-28
- 2021-04-06
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2021-04-10
Survey response — day 35, dose 2MedDRA: Back pain, Fatigue — Feeling: Fair · Be unable to do your normal daily activitiesFree text: extreme fatigue and mid back ache.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-19
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2021-06-04
Survey response — 3 months, dose 2MedDRA: Condition aggravated, Malignant melanoma, Pre-existing disease, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: My HPV that was dormant became active, turned an anal wart before vaccine did not look suspicious and 6 wks after 2nd moderna it now became malignant. · Healthcare visit (other): hematology/ radiation and surgeonMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-04
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2022-03-05
Survey response — 12 months, dose 2MedDRA: Cardiac flutter, Palpitations, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: heart ppalpitations and flutters, especially at night while resting or laying on left side. · Healthcare visit (other): also going for a heart consultation with cardiologistMedDRA releases: 2024-11 · check-in free text available
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2022-03-05
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
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2022-03-07
Call successfulReported to VAERS voluntarily prior to GDIT contact
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-05 | Moderna | |
| 2 | 2021-03-05 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-06-04 | Successful | Participant prefers to complete VAERS report online |
| 2022-03-05 | Successful 2022-03-07 |
Reported to VAERS voluntarily prior to GDIT contact |
Free text
Release 3 — day 0, dose 1
Systemic reaction (other): shortness of breath, anxiety
Release 5 — day 14, dose 2
Symptoms: extremely tired and headache every morning when i get up, then subsides.
Release 7 — day 35, dose 2
Symptoms: extreme fatigue and mid back ache.
Release 8 — 3 months, dose 2
Symptoms: My HPV that was dormant became active, turned an anal wart before vaccine did not look suspicious and 6 wks after 2nd moderna it now became malignant.
Healthcare visit (other): hematology/ radiation and surgeon
Release 11 — 12 months, dose 2
Symptoms: heart ppalpitations and flutters, especially at night while resting or laying on left side.
Healthcare visit (other): also going for a heart consultation with cardiologist
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 | Back pain | ✓ | ✓ | ✓ |
| SD | Cardiac flutter | · | · | ✓ |
| SD | Condition aggravated | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Malignant melanoma | ✓ | ✓ | ✓ |
| SD | Palpitations | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Anxiety | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release