Z5W-22476-11067
5 vaccinations
4 coded responses
49 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 100 / NY
- Registered
- 2021-01-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-28
Registered in v-safe
-
2021-01-28
Dose 1 — Moderna
- 2021-01-28
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
-
2021-02-11
Survey response — day 14, dose 1MedDRA: Medical observation, Pruritus, Rash — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Covid-armsevere rash and itching from elbow wrapping up left vaccinated arm to shoulder blade. Onset 2/11, worsened last night, took Xyzal and it was completely resolved this morning. PCP saw photo of my arm and confirmed Covid-arm. · Healthcare visit (other): Email through MyChart with photo of arm.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-11
Report sent to call center — day 14, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-18
-
2021-02-25
Dose 2 — Moderna
- 2021-02-25
-
2021-02-26
Survey response — days 1–6 daily, dose 2MedDRA: Tremor — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Hands trembled.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-01
-
2021-04-08
Survey response — day 42, dose 2MedDRA: Condition aggravated, Pre-existing disease — Feeling: GoodFree text: Reactivation of shingles lesion; second shingles vaccination was 1/2019.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-27
Survey response — 3 months, dose 2MedDRA: Chills, Nausea — Feeling: GoodFree text: Off and on very mild chills and nauseathink is over now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-07-20
- 2021-08-26
-
2021-11-01
Dose 3 — Moderna
- 2021-11-01
-
2021-11-02
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain, Swelling · Chills, Headache, Fatigue or tirednessAdult check-in
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-06
- 2021-11-07
- 2021-11-08
- 2021-11-17
- 2021-11-22
- 2021-11-29
- 2021-12-06
- 2021-12-13
- 2022-01-31
-
2022-04-02
Dose 4 — Moderna
- 2022-04-19
- 2022-04-23
- 2022-04-30
- 2022-05-07
- 2022-05-14
- 2022-07-02
-
2022-09-08
Dose 5 — Moderna
- 2022-10-01
- 2022-10-22
- 2022-12-08
- 2023-03-09
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-28 | Moderna | |
| 2 | 2021-02-25 | Moderna | |
| 3 | 2021-11-01 | Moderna | No |
| 4 | 2022-04-02 | Moderna | No |
| 5 | 2022-09-08 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-02-11 | Unsuccessful |
Free text
Release 4 — day 14, dose 1
Symptoms: Covid-armsevere rash and itching from elbow wrapping up left vaccinated arm to shoulder blade. Onset 2/11, worsened last night, took Xyzal and it was completely resolved this morning. PCP saw photo of my arm and confirmed Covid-arm.
Healthcare visit (other): Email through MyChart with photo of arm.
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Hands trembled.
Release 7 — day 42, dose 2
Symptoms: Reactivation of shingles lesion; second shingles vaccination was 1/2019.
Release 8 — 3 months, dose 2
Symptoms: Off and on very mild chills and nauseathink is over now.
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 | Medical observation | ✓ | ✓ | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Condition aggravated | ✓ | ✓ | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Pruritus | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SRO | Tremor | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release