ZJH-14090-64200
5 vaccinations
4 coded responses
22 check-ins
4 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 933 / CA
- Registered
- 2021-03-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-23
Dose 1 — Moderna
-
2021-03-23
Dose 2 — Moderna
-
2021-03-24
Registered in v-safe
-
2021-03-24
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-03-25
Survey response — days 1–6 daily, dose 2MedDRA: Erythema, Lymph node pain, Lymphadenopathy — Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesFree text: 2-inch bump right next to left collarbone. Very sore to touch & red.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-26
Survey response — days 1–6 daily, dose 2MedDRA: Lymph node pain, Lymphadenopathy — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to workFree text: Red bump near left collarbone is still sore & very tender to touch.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-27
Survey response — days 1–6 daily, dose 2MedDRA: Erythema, Pain, Swelling, Tenderness — Feeling: Good · Fatigue or tirednessFree text: Red bump has gotten smaller, but also seems to have moved a little bit to the left. It has gotten smaller but still throbs & is painful to touchMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-29
- 2021-03-30
- 2021-04-06
- 2021-04-15
- 2021-04-20
- 2021-04-27
- 2021-05-04
- 2021-06-24
- 2021-09-21
-
2021-12-01
Dose 3 — Moderna
- 2022-03-24
-
2022-05-16
Dose 4 — Moderna
-
2022-09-14
Dose 5 — Moderna
- 2022-09-25
- 2022-09-28
- 2022-10-05
- 2022-10-12
- 2022-10-19
- 2022-10-26
-
2022-12-14
Survey response — 3 months, dose 5MedDRA: Office visit, SARS-CoV-2 test negative, Sinusitis — 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: Sinus infection.. it was the first one in four years. Thought it could be COVID but tested & negative & saw doctor & it was a sinus infectionMedDRA releases: 2024-11 · check-in free text available
-
2022-12-14
Report sent to call center — 3 months, dose 5Be 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)
- 2022-12-15
- 2023-03-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-23 | Moderna | |
| 2 | 2021-03-23 | Moderna | |
| 3 | 2021-12-01 | Moderna | No |
| 4 | 2022-05-16 | Moderna | No |
| 5 | 2022-09-14 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-12-14 | Unsuccessful |
Free text
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): 2-inch bump right next to left collarbone. Very sore to touch & red.
Systemic reaction (other): Red bump near left collarbone is still sore & very tender to touch.
Systemic reaction (other): Red bump has gotten smaller, but also seems to have moved a little bit to the left. It has gotten smaller but still throbs & is painful to touch
Release 12 — 3 months, dose 5
Symptoms: Sinus infection.. it was the first one in four years. Thought it could be COVID but tested & negative & saw doctor & it was a sinus infection
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 | Office visit | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Lymph node pain | ✓ | ✓ | ✓ |
| SRO | Lymphadenopathy | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Swelling | ✓ | ✓ | ✓ |
| SRO | Tenderness | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release