YA3-10552-03768
5 vaccinations
5 coded responses
37 check-ins
5 free-text entries
1 call case
- Sex
- —
- Age at first dose
- 66+
- ZIP prefix
- 537 / WI
- Registered
- 2021-02-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-18
Dose 1 — Moderna
-
2021-02-19
Registered in v-safe
-
2021-02-19
Survey response — days 1–6 daily, dose 1MedDRA: Chillblains, Fatigue — Feeling: GoodFree text: Had mild fatigue and a few chills yesterday in the first 3-4 hours after the vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-02-27
- 2021-03-04
- 2021-03-11
-
2021-03-18
Dose 2 — Moderna
- 2021-03-18
-
2021-03-19
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-20
Survey response — days 1–6 daily, dose 2MedDRA: Decreased appetite — Feeling: Good · Site: Pain, RednessFree text: Mildly decreased appetiteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-03-24
- 2021-03-25
- 2021-04-01
- 2021-04-08
- 2021-04-16
- 2021-04-22
- 2021-04-29
- 2021-06-17
- 2021-09-16
-
2021-11-16
Dose 3 — Moderna
-
2022-03-18
Survey response — 12 months, dose 2MedDRA: Cardiac murmur, Echocardiogram abnormal — Feeling: GoodFree text: Mild heart murmer...mild changes on follow up echo cardiogramMedDRA releases: 2024-11 · check-in free text available
-
2022-04-11
Dose 4 — Moderna
- 2022-04-29
- 2022-05-02
- 2022-05-09
- 2022-05-16
- 2022-05-23
- 2022-07-11
-
2022-09-19
Dose 5 — Moderna
-
2022-10-10
Survey response — 6 months, dose 4MedDRA: Hypertension, Hypoaesthesia, Paraesthesia — Feeling: Good · Be unable to do your normal daily activitiesFree text: Developed high blood pressure requiring treatment, first noted 10 days after my 5th Covid (bivalent) shot. I also had a reaction immediately following the injection (timgling/numbness in my face and neck) - similar to how I feel when my BP is upMedDRA releases: 2024-11 · check-in free text available
-
2022-10-11
Survey response — day 21, dose 5MedDRA: Hypertension — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: High blood pressireMedDRA releases: 2024-11 · check-in free text available
-
2022-10-11
Report sent to call center — day 21, dose 5Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2022-10-12
-
2022-10-12
Call successfulDoes not wish to fill out VAERS report
- 2022-10-17
- 2022-10-25
- 2022-10-31
- 2022-12-21
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-18 | Moderna | |
| 2 | 2021-03-18 | Moderna | |
| 3 | 2021-11-16 | Moderna | No |
| 4 | 2022-04-11 | Moderna | No |
| 5 | 2022-09-19 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-11 | Successful 2022-10-12 |
Does not wish to fill out VAERS report |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Had mild fatigue and a few chills yesterday in the first 3-4 hours after the vaccine
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Mildly decreased appetite
Release 11 — 12 months, dose 2
Symptoms: Mild heart murmer...mild changes on follow up echo cardiogram
Release 12 — 6 months, dose 4
Symptoms: Developed high blood pressure requiring treatment, first noted 10 days after my 5th Covid (bivalent) shot. I also had a reaction immediately following the injection (timgling/numbness in my face and neck) - similar to how I feel when my BP is up
Release 12 — day 21, dose 5
Symptoms: High blood pressire
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 | Cardiac murmur | · | · | ✓ |
| SD | Echocardiogram abnormal | · | · | ✓ |
| SD | Hypertension | · | · | ✓ |
| SD | Hypoaesthesia | · | · | ✓ |
| SD | Paraesthesia | · | · | ✓ |
| SRO | Chillblains | ✓ | ✓ | ✓ |
| SRO | Decreased appetite | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release