Z4K-32388-87797
2 vaccinations
5 coded responses
20 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 891 / NV
- Registered
- 2021-06-15
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-06-15
Registered in v-safe
-
2021-06-15
Dose 1 — Moderna
-
2021-06-15
Survey response — day 0, dose 1MedDRA: Unevaluable event — Feeling: Good · Site: PainFree text: Bugs trying to poke me in the area of the shot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-16
- 2021-06-17
- 2021-06-18
- 2021-06-19
- 2021-06-20
-
2021-06-22
Survey response — day 7, dose 1MedDRA: Parosmia — Feeling: Fair · Site: Pain · Joint pains · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Bugs are flying in and out of my house that smell pretty bad. Scents smell like mildew and pollens.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-22
Report sent to call center — day 7, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-28
-
2021-06-29
Survey response — day 14, dose 1MedDRA: Hospitalisation, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Bugs spraying. Germs · Healthcare visit (other): In patient. CareMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-29
Report sent to call center — day 14, dose 1Get care from a doctor or other healthcare professional1 call case(s)
-
2021-07-02
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-07-06
Survey response — day 21, dose 1MedDRA: Unevaluable event — Feeling: FairFree text: Bugs, spiders, are trying to poke and spray bad smells like mildew there inside the bathroom everyday.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-07-13
Dose 2 — Moderna
- 2021-07-13
- 2021-07-14
- 2021-07-15
- 2021-07-16
- 2021-07-18
- 2021-07-19
- 2021-07-20
- 2021-08-03
- 2021-08-10
- 2021-08-17
-
2021-08-24
Survey response — day 42, dose 2MedDRA: Unevaluable event, Urticaria — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Hives: on the face and body. At work, home that bothers(smelly dragon fly orders) customers. Too many DND' for my GRA's.MedDRA releases: 2021-09,2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-06-15 | Moderna | |
| 2 | 2021-07-13 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-06-22 | Unsuccessful | |
| 2021-06-29 | Successful 2021-07-02 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 9 — day 0, dose 1
Systemic reaction (other): Bugs trying to poke me in the area of the shot.
Release 9 — day 7, dose 1
Systemic reaction (other): Bugs are flying in and out of my house that smell pretty bad. Scents smell like mildew and pollens.
Release 9 — day 14, dose 1
Release 9 — day 21, dose 1
Symptoms: Bugs, spiders, are trying to poke and spray bad smells like mildew there inside the bathroom everyday.
Release 9 — day 42, dose 2
Symptoms: Hives: on the face and body. At work, home that bothers(smelly dragon fly orders) customers. Too many DND' for my GRA's.
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 | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Urticaria | ✓ | · | ✓ |
| SRO | Parosmia | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release