YNJ-26684-79875
3 vaccinations
11 coded responses
38 check-ins
11 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 352 / AL
- Registered
- 2021-01-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-11
Registered in v-safe
-
2021-01-11
Dose 1 — Moderna
- 2021-01-11
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2021-01-12
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body achesAdult check-in
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2021-01-13
Survey response — days 1–6 daily, dose 1MedDRA: Vision blurred — Feeling: Fair · Site: Pain · Muscle or body achesFree text: Monday and tuesday, had blurry vision, but okay today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-25
- 2021-02-01
-
2021-02-08
Dose 2 — Moderna
- 2021-02-08
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2021-02-09
Survey response — days 1–6 daily, dose 2MedDRA: Back pain — Feeling: Poor · Site: Pain, Swelling, Itching · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: Back painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-10
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2021-02-11
Survey response — days 1–6 daily, dose 2MedDRA: Thrombosis, Varicose vein — Feeling: Fair · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Blood clot in lower left leg, varicose veinMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-12
Survey response — days 1–6 daily, dose 2MedDRA: Pre-existing disease, Thrombosis — Feeling: Fair · Site: Pain · Joint painsFree text: Blood clot in varicose vein, may be coincidence but began 2nd day.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-13
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Peripheral vein thrombosis — Feeling: Fair · Joint painsFree text: Pain in knee, peripheral vein blood clotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-14
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2021-02-15
Survey response — day 7, dose 2MedDRA: Gait disturbance, Loss of personal independence in daily activities, Vision blurred — Feeling: Fair · Joint painsFree text: Blurry vision left eyes, eas difficult to drive, trouble walking on knee.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-22
Survey response — day 14, dose 2MedDRA: Fatigue, Myalgia — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Fatigue, muscle aches,MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-08
Survey response — day 28, dose 2MedDRA: Vision blurred — Feeling: FairFree text: Continue to have blurry vision in left eyeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-15
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2021-03-23
Survey response — day 42, dose 2MedDRA: Arthralgia, Feeling hot, Joint swelling, Rash, Rash erythematous, Rash pruritic — Feeling: FairFree text: Rash on top of wrist and hands, both, but worse on left wrist where i initially had swelljng and pain after vaccine. Rash is pink to red, itchy and hot, mostly over wrist joint.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-10
- 2021-08-11
- 2022-02-08
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2022-05-23
Dose 3 — Moderna
- 2022-05-23
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2022-05-24
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2022-05-25
- 2022-05-26
- 2022-05-28
- 2022-05-29
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2022-05-30
Survey response — day 7, dose 3MedDRA: Unevaluable event — Feeling: Fair · Joint painsFree text: Shoulder above injectionMedDRA releases: 2024-11 · check-in free text available
- 2022-06-06
- 2022-06-13
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2022-06-20
Survey response — day 28, dose 3MedDRA: COVID-19, Malaise — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Became sick with Covid 19.MedDRA releases: 2024-11 · check-in free text available
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2022-06-20
Report sent to call center — day 28, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-06-21
- 2022-06-28
- 2022-07-04
- 2022-08-22
- 2023-05-25
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-08 | Moderna | |
| 3 | 2022-05-23 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-06-20 | Unsuccessful |
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Monday and tuesday, had blurry vision, but okay today.
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): Back pain
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Blood clot in lower left leg, varicose vein
Systemic reaction (other): Blood clot in varicose vein, may be coincidence but began 2nd day.
Systemic reaction (other): Pain in knee, peripheral vein blood clot
Release 4 — day 7, dose 2
Systemic reaction (other): Blurry vision left eyes, eas difficult to drive, trouble walking on knee.
Release 4 — day 14, dose 2
Symptoms: Fatigue, muscle aches,
Release 5 — day 28, dose 2
Symptoms: Continue to have blurry vision in left eye
Release 6 — day 42, dose 2
Symptoms: Rash on top of wrist and hands, both, but worse on left wrist where i initially had swelljng and pain after vaccine. Rash is pink to red, itchy and hot, mostly over wrist joint.
Release 11 — day 7, dose 3
Systemic reaction (other): Shoulder above injection
Release 12 — day 28, dose 3
Symptoms: Became sick with Covid 19.
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 | Arthralgia | ✓ | ✓ | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Feeling hot | ✓ | ✓ | ✓ |
| SD | Joint swelling | ✓ | ✓ | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Myalgia | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Rash erythematous | ✓ | ✓ | ✓ |
| SD | Rash pruritic | ✓ | ✓ | ✓ |
| SD | Vision blurred | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
| SRO | Gait disturbance | ✓ | ✓ | ✓ |
| SRO | Loss of personal independence in daily activities | ✓ | ✓ | ✓ |
| SRO | Peripheral vein thrombosis | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Thrombosis | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
| SRO | Varicose vein | ✓ | ✓ | ✓ |
| SRO | Vision blurred | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release