Z83-12808-64699
4 vaccinations
3 coded responses
43 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 339 / FL
- Registered
- 2021-01-25
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-22
Dose 1 — Moderna
-
2021-01-25
Registered in v-safe
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-01-29
- 2021-02-05
- 2021-02-14
- 2021-02-19
-
2021-02-22
Dose 2 — Moderna
- 2021-02-22
-
2021-02-23
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body achesAdult check-in
- 2021-02-24
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-03-03
- 2021-03-08
- 2021-03-15
- 2021-03-22
- 2021-03-31
- 2021-04-05
- 2021-05-26
- 2021-08-23
-
2021-10-26
Dose 3 — Moderna
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-09
- 2021-11-16
- 2021-11-25
- 2021-11-30
- 2021-12-08
- 2022-01-25
-
2022-04-11
Dose 4 — Moderna
-
2022-04-18
Survey response — day 7, dose 4MedDRA: Bone pain, Formication, Hyperhidrosis, Malaise, Pyrexia — Feeling: Fair · Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: On the day I received the fourth shot I felt fine. The next day I thought I was dying, I had a fever, every bone in my body ached my skin felt like there were bugs crawling on it. The next morning I woke up in a poodle sweat. I went for a walk arounMedDRA releases: 2024-11 · check-in free text available
-
2022-04-25
Survey response — day 14, dose 4MedDRA: Asthenia, Fatigue, Near death experience — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Very -Very Tired. I think that fourth shot almost killed me. I don't think I've recovered from it as of yet. Extremely tired, all my energy drained. This is so not like me. I would have never taking that fourth shot even though I'm 68 years old.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-04
- 2022-05-18
- 2022-05-23
- 2022-07-14
-
2022-10-10
Survey response — 6 months, dose 4MedDRA: COVID-19, Influenza, Influenza virus test positive, Malaise, Office visit, SARS-CoV-2 test positive — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: I went to California in July a week later I came down with the flu and COVID-19 both I tested positive for. I was never so sick in my 69 year's, I thought I was going to die! I went to several doctors and they helped me through it. · Healthcare visit (other): Urgent care and family doctorMedDRA releases: 2024-11 · check-in free text available
-
2022-10-10
Report sent to call center — 6 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-10-11
- 2023-04-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-02-22 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-04-11 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-10 | Unsuccessful |
Free text
Release 11 — day 7, dose 4
Systemic reaction (other): On the day I received the fourth shot I felt fine. The next day I thought I was dying, I had a fever, every bone in my body ached my skin felt like there were bugs crawling on it. The next morning I woke up in a poodle sweat. I went for a walk aroun cut off by CDC
Release 11 — day 14, dose 4
Symptoms: Very -Very Tired. I think that fourth shot almost killed me. I don't think I've recovered from it as of yet. Extremely tired, all my energy drained. This is so not like me. I would have never taking that fourth shot even though I'm 68 years old.
Release 12 — 6 months, dose 4
Symptoms: I went to California in July a week later I came down with the flu and COVID-19 both I tested positive for. I was never so sick in my 69 year's, I thought I was going to die! I went to several doctors and they helped me through it.
Healthcare visit (other): Urgent care and family doctor
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 | · | · | ✓ |
| SD | Asthenia | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Influenza virus test positive | · | · | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Near death experience | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Bone pain | · | · | ✓ |
| SRO | Formication | · | · | ✓ |
| SRO | Hyperhidrosis | · | · | ✓ |
| SRO | Malaise | · | · | ✓ |
| SRO | Pyrexia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release