ZXB-37002-75915
4 vaccinations
3 coded responses
38 check-ins
3 free-text entries
0 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 088 / NJ
- Registered
- 2021-01-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-18
Dose 1 — Moderna
-
2021-01-19
Registered in v-safe
- 2021-01-19
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-02-01
- 2021-02-08
-
2021-02-15
Dose 2 — Moderna
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-21
- 2021-02-22
-
2021-03-01
Survey response — day 14, dose 2MedDRA: Faeces discoloured, Pre-existing disease, Presyncope — Feeling: FairFree text: On the evening of 1/22 I experienced a near fainting spell followed by black stools the following day. Have a history of gastric ulcers and therefore have a scheduled endoscopy for March 5th.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-08
- 2021-03-15
- 2021-03-22
- 2021-03-29
- 2021-05-17
- 2021-08-16
-
2021-10-22
Dose 3 — Moderna
-
2021-10-26
Survey response — days 1–6 daily, dose 3MedDRA: Asthenia, Headache, Pain in extremity — Feeling: GoodFree text: No symptoms today but on 10/23/2021 I had soreness on the arm and a slight headache an weaknessMedDRA releases: 2024-11 · check-in free text available
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-11-10
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2022-01-21
-
2022-03-30
Dose 4 — Moderna
- 2022-04-18
- 2022-04-20
- 2022-04-27
- 2022-05-08
-
2022-05-11
Survey response — day 42, dose 4MedDRA: Laboratory test abnormal, Oropharyngeal pain, Productive cough — Feeling: FairFree text: Slight sore throat 2 days ago. Now a constant productive cough. Antigen test today was positive. PCR test done today, results pending.MedDRA releases: 2024-11 · check-in free text available
- 2023-03-30
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-18 | Moderna | |
| 2 | 2021-02-15 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-03-30 | Moderna | No |
Free text
Release 4 — day 14, dose 2
Symptoms: On the evening of 1/22 I experienced a near fainting spell followed by black stools the following day. Have a history of gastric ulcers and therefore have a scheduled endoscopy for March 5th.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): No symptoms today but on 10/23/2021 I had soreness on the arm and a slight headache an weakness
Release 11 — day 42, dose 4
Symptoms: Slight sore throat 2 days ago. Now a constant productive cough. Antigen test today was positive. PCR test done today, results pending.
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 | Faeces discoloured | ✓ | ✓ | ✓ |
| SD | Laboratory test abnormal | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Presyncope | ✓ | ✓ | ✓ |
| SD | Productive cough | · | · | ✓ |
| SRO | Asthenia | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release