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Z6W-27132-88264

5 vaccinations 7 coded responses 38 check-ins 7 free-text entries 3 call cases
Sex
Female
Age at first dose
66+
ZIP prefix
760 / TX
Registered
2021-01-12
Relationship
Self
Race
Black or African American
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-11
    Dose 1 — Moderna
  2. 2021-01-12
    Registered in v-safe
  3. 2021-01-12
    Survey response — days 1–6 daily, dose 1
    MedDRA: No adverse event — Feeling: Fair · Site: Pain · Headache, Nausea
    Free text: Don't eat greasey food and stay well hydrated
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-01-13
    Survey response — days 1–6 daily, dose 1
    MedDRA: Unevaluable event — Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to work
    Free text: No just beibg cause of fried food and the internet saud you shouldn't consume alcohol before or after the infection so that you don't weajend your immune system 😜. Im feeling just fine today.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-01-13
  6. 2021-01-14
    Survey response — days 1–6 daily, dose 1
    MedDRA: Injection site pain, Sleep disorder — Feeling: Good
    Free text: Very light muscle pain if I sleep on that arm or wear a bra strap on that muscle that was injected. Im not tired or bothered.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-01-15
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Diarrhea
    Adult check-in
  8. 2021-01-16
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-01-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-01-18
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-01-25
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-02-01
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-02-08
    Dose 2 — Moderna
  14. 2021-02-08
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-02-09
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Muscle or body aches, Diarrhea
    Adult check-in
  16. 2021-02-10
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-02-11
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · None
    Adult check-in
  18. 2021-02-12
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-02-13
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-02-14
    Survey response — days 1–6 daily, dose 2
    MedDRA: Unevaluable event — Feeling: Good
    Free text: Happy Valentines Day!!!
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-02-15
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  22. 2021-02-22
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-03-01
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-03-08
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-03-15
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-03-22
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-05-10
    Survey response — 3 months, dose 2
    MedDRA: Heart rate increased — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, Hospitalization
    Free text: Rapid heart beat
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  28. 2021-05-10
    Report sent to call center — 3 months, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  29. 2021-05-29
  30. 2021-08-09
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  31. 2021-10-25
    Dose 3 — Moderna
  32. 2021-10-26
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Swelling · None
    Adult check-in
  33. 2021-10-27
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  34. 2021-10-28
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  35. 2021-10-30
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  36. 2021-11-01
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  37. 2021-11-08
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  38. 2022-04-22
    Dose 4 — Moderna
  39. 2022-04-27
    Health check-in — 6 months, dose 3
    Feeling: Fair
    Adult check-in
  40. 2022-05-18
    Health check-in — day 21, dose 4
    Feeling: Good
    Adult check-in
  41. 2022-07-27
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in
  42. 2022-10-23
    Dose 5 — Moderna
    Co-administered: Flu
  43. 2022-10-23
    Health check-in — day 0, dose 5
    Feeling: Good · Site: Pain · None
    Adult check-in
  44. 2022-10-25
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · Nausea, Abdominal pain
    Adult check-in
  45. 2022-10-28
    Survey response — days 1–6 daily, dose 5
    MedDRA: Diarrhoea — Feeling: Good · Diarrhea
    Free text: I think the Diarrhea was my Pastors wife supper
    MedDRA releases: 2024-11 · check-in free text available
  46. 2022-11-01
    Health check-in — day 7, dose 5
    Feeling: Good · None
    Adult check-in
  47. 2022-11-20
    Survey response — day 28, dose 5
    MedDRA: Anxiety, Nervousness — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit
    Free text: Some type of nerve anxiety
    MedDRA releases: 2024-11 · check-in free text available
  48. 2022-11-20
    Report sent to call center — day 28, dose 5
    Get care from a doctor or other healthcare professional
    Emergency room or emergency department visit · 1 call case(s)
  49. 2022-11-21
  50. 2022-11-21
  51. 2022-11-21
    Call successful
    Does not wish to fill out VAERS report
  52. 2022-11-21
    Call successful
    Does not wish to fill out VAERS report

Vaccinations

DoseDateManufacturerCo-administered
12021-01-11Moderna
22021-02-08Moderna
32021-10-25Moderna No
42022-04-22Moderna No
52022-10-23Moderna Flu

Call center

ReportedOutcomeVAERS-related outcome
2021-01-13 priority 2/3
2021-05-10 Successful
2022-11-21
Does not wish to fill out VAERS report
2022-11-20 Successful
2022-11-21
Does not wish to fill out VAERS report

Free text

Release 1 — days 1–6 daily, dose 1

2021-01-12

Systemic reaction (other): Don't eat greasey food and stay well hydrated

2021-01-13

Systemic reaction (other): No just beibg cause of fried food and the internet saud you shouldn't consume alcohol before or after the infection so that you don't weajend your immune system 😜. Im feeling just fine today.

Release 2 — days 1–6 daily, dose 1

2021-01-14

Systemic reaction (other): Very light muscle pain if I sleep on that arm or wear a bra strap on that muscle that was injected. Im not tired or bothered.

Release 4 — days 1–6 daily, dose 2

2021-02-14

Systemic reaction (other): Happy Valentines Day!!!

Release 8 — 3 months, dose 2

2021-05-10

Symptoms: Rapid heart beat

Release 12 — days 1–6 daily, dose 5

2022-10-28

Systemic reaction (other): I think the Diarrhea was my Pastors wife supper

Release 12 — day 28, dose 5

2022-11-20

Symptoms: Some type of nerve anxiety

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

FieldPreferred term2021-092023-042024-11
SDAnxiety · · ✓
SDHeart rate increased ✓ ✓ ✓
SDNervousness · · ✓
SRODiarrhoea · · ✓
SROInjection site pain ✓ ✓ ✓
SRONo adverse event ✓ ✓ ✓
SROSleep disorder ✓ ✓ ✓
SROUnevaluable event ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release