Z88-28865-81489
5 vaccinations
2 coded responses
56 check-ins
2 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 802 / CO
- Registered
- 2021-03-20
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-20
Registered in v-safe
-
2021-03-20
Dose 1 — Moderna
-
2021-03-20
Health check-in — day 0, dose 1Feeling: Fair · Site: Pain, Itching · Fever · Headache, Fatigue or tirednessAdult check-in
-
2021-03-21
Survey response — days 1–6 daily, dose 1MedDRA: Exercise adequate, Pre-existing disease — Feeling: Good · Site: Pain, ItchingFree text: I have CRPS RT-Arm, 14 years since diagnosed.Vaccine given on left arm. Celiac Disease. Breast Cancer survivor, left breasr lumpectomy Aug 2019. 5'1, 117 lbs., extremely active - exercise daily.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-22
- 2021-03-24
- 2021-03-25
- 2021-03-26
- 2021-03-27
- 2021-04-03
- 2021-04-10
-
2021-04-17
Dose 2 — Moderna
- 2021-04-17
-
2021-04-19
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Swelling, Itching · NoneAdult check-in
- 2021-04-20
- 2021-04-21
-
2021-04-22
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-04-23
- 2021-04-24
- 2021-05-01
- 2021-05-08
- 2021-05-15
-
2021-05-22
Survey response — day 35, dose 2MedDRA: Herpes zoster, Injection site erythema, Medical counselling, Office visit, Petechiae — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visitFree text: Nurse hotline advised to good to nearest emergency room due to Petechiae on face and neck after Shingles vaccine, first dose on Monday, May 17th. Red spots appeared on Wednesat 9:30 AM and disappeared 2 hours. Nurse had me take snapshot on my mobileMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-22
Report sent to call center — day 35, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-29
- 2021-07-17
-
2021-09-14
Dose 3 — Moderna
-
2021-09-14
Health check-in — day 0, dose 3Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-09-15
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-09-16
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
- 2021-09-17
- 2021-09-18
- 2021-09-19
- 2021-09-20
- 2021-09-21
- 2021-09-28
- 2021-10-05
- 2021-10-12
- 2021-10-19
- 2021-10-26
- 2021-12-16
- 2022-02-14
-
2022-02-28
Dose 4 — Moderna
- 2022-03-01
- 2022-03-02
- 2022-03-03
- 2022-03-04
- 2022-03-05
- 2022-03-06
- 2022-03-07
- 2022-03-14
- 2022-03-21
- 2022-03-28
- 2022-04-04
- 2022-04-11
- 2022-05-30
-
2022-09-21
Dose 5 — Moderna
- 2022-09-28
- 2022-10-06
- 2022-10-13
- 2022-10-21
- 2022-11-04
- 2022-12-22
- 2023-03-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-20 | Moderna | |
| 2 | 2021-04-17 | Moderna | |
| 3 | 2021-09-14 | Moderna | No |
| 4 | 2022-02-28 | Moderna | No |
| 5 | 2022-09-21 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-05-22 | Unsuccessful |
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): I have CRPS RT-Arm, 14 years since diagnosed.Vaccine given on left arm. Celiac Disease. Breast Cancer survivor, left breasr lumpectomy Aug 2019. 5'1, 117 lbs., extremely active - exercise daily.
Release 8 — day 35, dose 2
Symptoms: Nurse hotline advised to good to nearest emergency room due to Petechiae on face and neck after Shingles vaccine, first dose on Monday, May 17th. Red spots appeared on Wednesat 9:30 AM and disappeared 2 hours. Nurse had me take snapshot on my mobile cut off by CDC
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 | Herpes zoster | ✓ | ✓ | ✓ |
| SD | Injection site erythema | ✓ | ✓ | ✓ |
| SD | Medical counselling | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Petechiae | ✓ | ✓ | ✓ |
| SRO | Exercise adequate | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release