Z42-69919-93213
3 vaccinations
5 coded responses
30 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 41-45
- ZIP prefix
- 180 / PA
- Registered
- 2021-01-07
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-07
Registered in v-safe
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2021-01-07
Dose 1 — Moderna
- 2021-01-07
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2021-01-08
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-01-09
- 2021-01-10
- 2021-01-11
- 2021-01-12
- 2021-01-13
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2021-01-14
Survey response — day 7, dose 1MedDRA: Axillary pain, Contusion, Oedema peripheral — Feeling: FairFree text: The armpit, on the arm of the injection, is bruised, swollen, and very painfulMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-21
Survey response — day 14, dose 1MedDRA: Injection site pruritus — Feeling: GoodFree text: Itchy injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-28
-
2021-02-04
Dose 2 — Moderna
- 2021-02-04
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2021-02-05
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Itching · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
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2021-02-06
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness, Itching · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-02-07
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling, Itching · NoneAdult check-in
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2021-02-08
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Redness, Swelling, Itching · Headache, NauseaAdult check-in
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2021-02-09
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Swelling, Itching · NauseaAdult check-in
-
2021-02-10
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Itching · NauseaAdult check-in
- 2021-02-11
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2021-02-18
Survey response — day 14, dose 2MedDRA: Contusion, Erythema, Tenderness — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Redness, bruising on bilateral lower legs. Painful to touchMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-18
Report sent to call center — day 14, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-08-05
Survey response — 6 months, dose 2MedDRA: Hospitalisation, Rash — Feeling: Fair · Be unable to work or attend school, 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: Developed a rash 10 days after 2nd vaccination that required hospitalization for 4 days. Treated for 30 w prednisone now gone. Md felt it was a side effect of the 2nd shot. Now have a ton of hospital billsMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-05
Report sent to call center — 6 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2021-08-06
- 2021-08-09
- 2021-08-12
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2021-08-13
Callback requested for04:30P EST
- 2021-08-16
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2021-10-26
Dose 3 — Moderna
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2021-10-27
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain, Swelling · Fever · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Lymphadenopathy, Pain, Pruritus — Feeling: Fair · Site: Pain, Redness, Itching · Fatigue or tirednessFree text: Swollen lymph nodes on neck and in armpit/ breast on side of injection. Painful itchyMedDRA releases: 2024-11 · check-in free text available
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2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Swelling, Itching · Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-10-30
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Itching · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-10-31
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2021-11-01
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fatigue or tiredness, DiarrheaAdult check-in
- 2021-11-02
- 2021-11-16
- 2021-11-23
- 2022-04-26
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-07 | Moderna | |
| 2 | 2021-02-04 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-02-18 | Unsuccessful | |
| 2021-08-05 | Unsuccessful |
Free text
Release 2 — day 7, dose 1
Systemic reaction (other): The armpit, on the arm of the injection, is bruised, swollen, and very painful
Release 2 — day 14, dose 1
Symptoms: Itchy injection site
Release 4 — day 14, dose 2
Symptoms: Redness, bruising on bilateral lower legs. Painful to touch
Release 9 — 6 months, dose 2
Symptoms: Developed a rash 10 days after 2nd vaccination that required hospitalization for 4 days. Treated for 30 w prednisone now gone. Md felt it was a side effect of the 2nd shot. Now have a ton of hospital bills
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Swollen lymph nodes on neck and in armpit/ breast on side of injection. Painful itchy
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 | Contusion | ✓ | ✓ | ✓ |
| SD | Erythema | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | · | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | · | ✓ |
| SD | Tenderness | ✓ | ✓ | ✓ |
| SRO | Axillary pain | ✓ | ✓ | ✓ |
| SRO | Contusion | ✓ | ✓ | ✓ |
| SRO | Lymphadenopathy | · | · | ✓ |
| SRO | Oedema peripheral | ✓ | ✓ | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Pruritus | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release