Z7D-11296-18331
5 vaccinations
8 coded responses
61 check-ins
7 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 161 / PA
- Registered
- 2021-02-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-10
Dose 1 — Moderna
-
2021-02-12
Registered in v-safe
-
2021-02-12
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-24
- 2021-03-03
-
2021-03-10
Dose 2 — Moderna
-
2021-03-10
Survey response — day 0, dose 2MedDRA: No adverse event — Feeling: Good · Site: ItchingFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
-
2021-03-12
Survey response — days 1–6 daily, dose 2MedDRA: Abdominal discomfort, Pain — Feeling: Fair · Site: Pain, Redness, Swelling · Fatigue or tirednessFree text: Last night I felt achy and stomach was upset. Feel better today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-13
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
-
2021-03-14
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-24
- 2021-03-31
- 2021-04-07
- 2021-04-14
- 2021-04-21
- 2021-06-09
- 2021-09-09
-
2021-10-25
Dose 3 — Moderna
- 2021-10-28
-
2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
- 2021-10-30
-
2021-10-31
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Swelling · DiarrheaAdult check-in
- 2021-11-01
- 2021-11-08
- 2021-11-15
- 2021-11-22
- 2021-11-29
- 2021-12-06
- 2022-01-24
-
2022-04-15
Dose 4 — Moderna
-
2022-04-18
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Good · Site: Pain, SwellingFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-04-19
-
2022-04-20
Survey response — days 1–6 daily, dose 4MedDRA: Rash, Rash pruritic — Feeling: GoodFree text: The night I got the shot I woke up with a rash on both arms. It was very itchy. The next night I had a rash on my abdomen. I didn't connect it to the shot until today. I thought it was a reaction to a plant I had bought that day.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-21
- 2022-04-22
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-05-20
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2022-05-27
Survey response — day 42, dose 4MedDRA: Cough, Ear discomfort, Oropharyngeal pain — Feeling: FairFree text: I've had a sore throat with a cough for a week. My ear is plugged on one side. Sore throat is gone but still coughing. No fever.MedDRA releases: 2024-11 · check-in free text available
-
2022-07-15
Survey response — 3 months, dose 4MedDRA: Bronchitis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: I had bronchitis for ten weeks.MedDRA releases: 2024-11 · check-in free text available
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2022-07-15
Report sent to call center — 3 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-07-18
-
2022-07-20
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-10-14
Dose 5 — Moderna
- 2022-10-14
- 2022-10-14
- 2022-10-15
- 2022-10-16
- 2022-10-17
- 2022-10-18
- 2022-10-19
- 2022-10-20
- 2022-10-21
-
2022-10-28
Survey response — day 14, dose 5MedDRA: Pain in extremity — Feeling: GoodFree text: My arm was very sore for three weeks. Just now feeling better.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-04
- 2022-11-11
- 2022-11-18
- 2022-11-25
- 2023-01-13
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2023-04-14
Survey response — 6 months, dose 5MedDRA: COVID-19 — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationMedDRA releases: 2024-11
-
2023-04-14
Report sent to call center — 6 months, dose 5Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2023-04-17
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-10 | Moderna | |
| 2 | 2021-03-10 | Moderna | |
| 3 | 2021-10-25 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
| 5 | 2022-10-14 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-07-15 | Successful 2022-07-20 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-04-14 | Successful 2023-04-17 |
Does not wish to fill out VAERS report |
Free text
Release 5 — day 0, dose 2
Systemic reaction (other): No
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Last night I felt achy and stomach was upset. Feel better today.
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): No
Systemic reaction (other): The night I got the shot I woke up with a rash on both arms. It was very itchy. The next night I had a rash on my abdomen. I didn't connect it to the shot until today. I thought it was a reaction to a plant I had bought that day.
Release 11 — day 42, dose 4
Symptoms: I've had a sore throat with a cough for a week. My ear is plugged on one side. Sore throat is gone but still coughing. No fever.
Release 12 — 3 months, dose 4
Symptoms: I had bronchitis for ten weeks.
Release 12 — day 14, dose 5
Symptoms: My arm was very sore for three weeks. Just now feeling better.
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 | Bronchitis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Ear discomfort | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SRO | Abdominal discomfort | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Rash | · | · | ✓ |
| SRO | Rash pruritic | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release