ZJ5-23032-86284
5 vaccinations
6 coded responses
30 check-ins
5 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 117 / NY
- Registered
- 2021-11-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-05
Dose 1 — Moderna
-
2021-02-02
Dose 2 — Moderna
-
2021-11-04
Registered in v-safe
-
2021-11-04
Dose 3 — Moderna
- 2021-11-04
-
2021-11-05
Survey response — days 1–6 daily, dose 3MedDRA: Dyspepsia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: IndigestionMedDRA releases: 2024-11 · check-in free text available
-
2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-11-07
- 2021-11-08
- 2021-11-09
- 2021-11-11
- 2021-11-18
- 2021-11-25
- 2021-12-02
- 2021-12-09
- 2021-12-16
- 2022-02-03
- 2022-05-05
-
2022-05-19
Dose 4 — Moderna
- 2022-05-19
-
2022-05-20
Survey response — days 1–6 daily, dose 4MedDRA: Productive cough — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Nausea · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Phlegm in throatMedDRA releases: 2024-11 · check-in free text available
-
2022-05-21
Survey response — days 1–6 daily, dose 4MedDRA: Decreased appetite — Feeling: GoodFree text: Appetite still offMedDRA releases: 2024-11 · check-in free text available
- 2022-05-22
- 2022-05-23
- 2022-05-24
- 2022-05-25
- 2022-05-26
- 2022-06-02
- 2022-06-09
- 2022-06-16
- 2022-06-25
- 2022-06-30
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2022-08-18
Survey response — 3 months, dose 4MedDRA: COVID-19, Chills, Fatigue, Nasal congestion, Oropharyngeal pain, Pyrexia, Rhinorrhoea, Taste disorder — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Covid-19 - fever, chills (once rigorous teeth chattering), sore throat, nasal congestion, runny nose, fatigue, distortion of taste for a short time.MedDRA releases: 2024-11 · check-in free text available
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2022-11-17
Survey response — 6 months, dose 4MedDRA: COVID-19, Campylobacter gastroenteritis, Gastroenteritis vibrio, Hospitalisation, Medial tibial stress syndrome, Office visit, Septic shock — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Covid in Aug 2022 - shin splints as after effect - yes, orthopedic doctor stated they are from Covid. Nov. 6 - Severe gastroenteritis secondary to infection - vibio and campylobachter. Resulted in septic shock. Hospitalized 6 days.MedDRA releases: 2024-11 · check-in free text available
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2022-12-30
Dose 5 — Moderna
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2023-06-30
Survey response — 6 months, dose 5MedDRA: Breast hyperplasia, Extrasystoles, Herpes zoster, Office visit, Surgery — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-05 | Moderna | No |
| 2 | 2021-02-02 | Moderna | No |
| 3 | 2021-11-04 | Moderna | No |
| 4 | 2022-05-19 | Moderna | No |
| 5 | 2022-12-30 | Moderna | No |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Indigestion
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Phlegm in throat
Systemic reaction (other): Appetite still off
Release 12 — 3 months, dose 4
Symptoms: Covid-19 - fever, chills (once rigorous teeth chattering), sore throat, nasal congestion, runny nose, fatigue, distortion of taste for a short time.
Release 12 — 6 months, dose 4
Symptoms: Covid in Aug 2022 - shin splints as after effect - yes, orthopedic doctor stated they are from Covid. Nov. 6 - Severe gastroenteritis secondary to infection - vibio and campylobachter. Resulted in septic shock. Hospitalized 6 days.
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 | · | · | ✓ |
| HCVO | Surgery | · | · | ✓ |
| SD | Breast hyperplasia | · | · | ✓ |
| SD | Campylobacter gastroenteritis | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Extrasystoles | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Gastroenteritis vibrio | · | · | ✓ |
| SD | Herpes zoster | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Medial tibial stress syndrome | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Septic shock | · | · | ✓ |
| SD | Taste disorder | · | · | ✓ |
| SRO | Decreased appetite | · | · | ✓ |
| SRO | Dyspepsia | · | · | ✓ |
| SRO | Productive cough | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release