Z64-13504-30203
2 vaccinations
5 coded responses
12 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 100 / NY
- Registered
- 2021-04-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-23
Dose 1 — Moderna
-
2021-04-20
Dose 2 — Moderna
-
2021-04-23
Registered in v-safe
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2021-04-23
Survey response — days 1–6 daily, dose 2MedDRA: Ageusia, Anosmia, Anxiety, Decreased appetite, Dysgeusia, Irritability, Sinus congestion, Thirst — Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, NauseaFree text: Anxiety, irritability, very thirsty, no appetite, no taste or smell, strange taste in mouth, sinus congestion.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-25
- 2021-04-26
- 2021-04-29
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2021-05-04
Survey response — day 14, dose 2MedDRA: Dizziness, Fatigue — Feeling: GoodFree text: Over the weekend and yesterday, I had extreme fatigue and dizziness. Ive been like that on and off since shot 2 on 4/20/21. Ive also had these symptoms before COVID19 and both shots.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-12
- 2021-05-18
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2021-05-27
Survey response — day 35, dose 2MedDRA: Asthenia, Dizziness, Fatigue, Headache, Office visit, Oropharyngeal pain, SARS-CoV-2 test, Sinus congestion, Upper-airway cough syndrome — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Actually Ive had ongoing fatigue, weakness, dizziness, headaches, sinus congestion, bad post nasal drip and sore throat on and off (but often) since my last Moderna shot 4/20/21. I do have seasonal and dust allergies all year. · Healthcare visit (other): Saw my regular Internist/Endocrinologist and Cardiologist for evaluation and testing. Also had a nasal COVID19 test this week. Waiting for results.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-27
Report sent to call center — day 35, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-06-01
Survey response — day 42, dose 2MedDRA: Cough, Dizziness, Fatigue, Headache, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test negative, Upper-airway cough syndrome — Feeling: FairFree text: Still am very tired, dizzy and weak-especially when I get up in the morning.Also have nasal congestion, post nasal drip and headaches.I just tested negative for COVID19 last week.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-07-20
Survey response — 3 months, dose 2MedDRA: Gastrooesophageal reflux disease, Headache, Oropharyngeal pain, Sinus congestion, Upper-airway cough syndrome — Feeling: FairFree text: Stomach and acid reflux issues.Bad headaches, sinus congestion and sore throat. Very bad post nasal drip.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-19
- 2022-04-20
- 2022-04-27
-
2022-04-29
Callback requested for12:30PM ET
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2022-04-29
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-23 | Moderna | |
| 2 | 2021-04-20 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-05-27 | Successful 2022-04-29 |
Does not wish to fill out VAERS report |
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Anxiety, irritability, very thirsty, no appetite, no taste or smell, strange taste in mouth, sinus congestion.
Release 8 — day 14, dose 2
Symptoms: Over the weekend and yesterday, I had extreme fatigue and dizziness. Ive been like that on and off since shot 2 on 4/20/21. Ive also had these symptoms before COVID19 and both shots.
Release 8 — day 35, dose 2
Symptoms: Actually Ive had ongoing fatigue, weakness, dizziness, headaches, sinus congestion, bad post nasal drip and sore throat on and off (but often) since my last Moderna shot 4/20/21. I do have seasonal and dust allergies all year.
Healthcare visit (other): Saw my regular Internist/Endocrinologist and Cardiologist for evaluation and testing. Also had a nasal COVID19 test this week. Waiting for results.
Release 8 — day 42, dose 2
Symptoms: Still am very tired, dizzy and weak-especially when I get up in the morning.Also have nasal congestion, post nasal drip and headaches.I just tested negative for COVID19 last week.
Release 9 — 3 months, dose 2
Symptoms: Stomach and acid reflux issues.Bad headaches, sinus congestion and sore throat. Very bad post nasal drip.
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 | Office visit | ✓ | ✓ | ✓ |
| HCVO | SARS-CoV-2 test | ✓ | ✓ | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Dizziness | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Gastrooesophageal reflux disease | · | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Nasal congestion | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SD | Sinus congestion | ✓ | ✓ | ✓ |
| SD | Upper-airway cough syndrome | ✓ | ✓ | ✓ |
| SRO | Ageusia | ✓ | ✓ | ✓ |
| SRO | Anosmia | ✓ | ✓ | ✓ |
| SRO | Anxiety | ✓ | ✓ | ✓ |
| SRO | Decreased appetite | ✓ | ✓ | ✓ |
| SRO | Dysgeusia | ✓ | ✓ | ✓ |
| SRO | Irritability | ✓ | ✓ | ✓ |
| SRO | Sinus congestion | ✓ | ✓ | ✓ |
| SRO | Thirst | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release