Z49-17317-53606
3 vaccinations
5 coded responses
18 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 981 / WA
- Registered
- 2021-05-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-30
Dose 1 — Moderna
-
2021-05-01
Registered in v-safe
- 2021-05-01
-
2021-05-28
Dose 2 — Moderna
- 2021-06-08
- 2021-06-13
- 2021-06-18
- 2021-06-26
-
2021-07-03
Survey response — day 35, dose 2MedDRA: Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Activated immune system aggravated by record heat and wildfire smoke.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-07-09
Survey response — day 42, dose 2MedDRA: Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Sprained tooth acting up again. Extreme heat aggravates allergies with high NO2 and wildfire smoke.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-08-29
-
2021-11-22
Call successfulParticipant prefers to complete VAERS report online
- 2021-11-26
-
2022-05-23
Dose 3 — Moderna
-
2022-05-28
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Muscle or body aches · Be unable to do your normal daily activitiesAdult check-in
-
2022-05-28
Survey response — 12 months, dose 2MedDRA: Chromaturia, Condition aggravated, Pre-existing disease, Urine abnormality — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Red, cloudy urine, post booster on 23 May 2022. I suspect autoimmune flare, as likely from high pollen as booster challenge.MedDRA releases: 2024-11 · check-in free text available
- 2022-06-01
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2022-06-11
Survey response — day 14, dose 3MedDRA: Chromaturia, Hypersomnia, Urine abnormality — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Red, clouded urine, likely autoimmune related. Sleeping 12+ hours a day.MedDRA releases: 2024-11 · check-in free text available
- 2022-06-21
- 2022-06-28
- 2022-08-25
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2022-11-21
Survey response — 6 months, dose 3MedDRA: Blood urine present, Haemoglobin decreased, Office visit, Pre-existing disease, Vitamin B12 decreased — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I had blood in my urine following May 2022 booster. Last visit with doctor revealed low Vitamin B12 + low hemoglobin. I have an activated immune system from quinone chemo in 2008 (I carry quinone reductase variant that poorly metabolizes quinones).MedDRA releases: 2024-11 · check-in free text available
-
2022-11-21
Report sent to call center — 6 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-05-25
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-30 | Moderna | |
| 2 | 2021-05-28 | Moderna | |
| 3 | 2022-05-23 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-11-21 | Successful 2021-11-22 |
Participant prefers to complete VAERS report online |
Free text
Release 9 — day 35, dose 2
Symptoms: Activated immune system aggravated by record heat and wildfire smoke.
Release 9 — day 42, dose 2
Symptoms: Sprained tooth acting up again. Extreme heat aggravates allergies with high NO2 and wildfire smoke.
Release 11 — 12 months, dose 2
Symptoms: Red, cloudy urine, post booster on 23 May 2022. I suspect autoimmune flare, as likely from high pollen as booster challenge.
Release 12 — day 14, dose 3
Symptoms: Red, clouded urine, likely autoimmune related. Sleeping 12+ hours a day.
Release 12 — 6 months, dose 3
Symptoms: I had blood in my urine following May 2022 booster. Last visit with doctor revealed low Vitamin B12 + low hemoglobin. I have an activated immune system from quinone chemo in 2008 (I carry quinone reductase variant that poorly metabolizes quinones). cut off by CDC
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 | Blood urine present | · | · | ✓ |
| SD | Chromaturia | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Haemoglobin decreased | · | · | ✓ |
| SD | Hypersomnia | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Urine abnormality | · | · | ✓ |
| SD | Vitamin B12 decreased | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release