Z9G-18244-07421
2 vaccinations
5 coded responses
24 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 373 / TN
- Registered
- 2021-01-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-16
Dose 1 — Moderna
-
2021-01-17
Registered in v-safe
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-21
- 2021-01-22
- 2021-01-23
- 2021-02-01
- 2021-02-06
-
2021-02-13
Dose 2 — Moderna
- 2021-02-13
-
2021-02-14
Survey response — days 1–6 daily, dose 2MedDRA: Erythema, Feeling hot, Pre-existing disease — Feeling: Good · Site: Pain · Fever · Headache · Be unable to do your normal daily activitiesFree text: My right cheek and ear turned red and hot, the same way it does when I take a Medrol (prednisolone). I have Sjogrens.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-15
Survey response — days 1–6 daily, dose 2MedDRA: Injection site rash, Injection site swelling, Injection site urticaria — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: I have a rash/welt about 1 1/2 inch, roundish, with raised edge, on the arm I got the shot - but its about four inches from the site. So Im not sure it has anything to do with the vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-16
-
2021-02-17
Survey response — days 1–6 daily, dose 2MedDRA: Oropharyngeal pain — Feeling: GoodFree text: Slight sore throat last night and this morning, gone now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-27
- 2021-03-06
- 2021-03-13
- 2021-03-20
- 2021-03-27
-
2021-05-15
Survey response — 3 months, dose 2MedDRA: Basal cell carcinoma — Feeling: GoodFree text: Basal cell cancer on forehead, removed in total using MOHS.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-08-14
-
2022-02-13
Survey response — 12 months, dose 2MedDRA: Colitis microscopic, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Microscopic colitis · Healthcare visit (other): In-person appt with Gastro and lower scope orderedMedDRA releases: 2024-11 · check-in free text available
-
2022-02-13
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2022-02-21
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-16 | Moderna | |
| 2 | 2021-02-13 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-02-13 | Unsuccessful |
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): My right cheek and ear turned red and hot, the same way it does when I take a Medrol (prednisolone). I have Sjogrens.
Systemic reaction (other): I have a rash/welt about 1 1/2 inch, roundish, with raised edge, on the arm I got the shot - but its about four inches from the site. So Im not sure it has anything to do with the vaccine.
Systemic reaction (other): Slight sore throat last night and this morning, gone now.
Release 8 — 3 months, dose 2
Symptoms: Basal cell cancer on forehead, removed in total using MOHS.
Release 11 — 12 months, dose 2
Symptoms: Microscopic colitis
Healthcare visit (other): In-person appt with Gastro and lower scope ordered
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 | Basal cell carcinoma | ✓ | ✓ | ✓ |
| SD | Colitis microscopic | · | · | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Feeling hot | ✓ | ✓ | ✓ |
| SRO | Injection site rash | ✓ | ✓ | ✓ |
| SRO | Injection site swelling | ✓ | ✓ | ✓ |
| SRO | Injection site urticaria | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release