2AH-19927-01479
4 vaccinations
6 coded responses
32 check-ins
6 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 245 / VA
- Registered
- 2021-02-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-03
Registered in v-safe
-
2021-02-03
Dose 1 — Moderna
- 2021-02-03
-
2021-02-04
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-02-05
Survey response — days 1–6 daily, dose 1MedDRA: Headache, Hypertension, Palpitations, Pyrexia — Feeling: Fair · Site: Pain · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Late yesterday I had fever, headache, heart racing, and blood pressure shot way up. Lasted about 4-5 hours & was after I had done my daily check in.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-05
Report sent to call center — days 1–6 daily, dose 1Get care from a doctor or other healthcare professional1 call case(s)
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2021-02-06
Survey response — days 1–6 daily, dose 1MedDRA: Dizziness, Syncope — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Light headed, faintMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-07
Survey response — days 1–6 daily, dose 1MedDRA: Asthenia, Dizziness — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Feel light headed and weakMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-08
- 2021-02-09
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2021-02-10
Health check-in — day 7, dose 1Feeling: Good · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-03-10
-
2021-03-12
Dose 2 — Moderna
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-02
-
2021-04-09
Survey response — day 28, dose 2MedDRA: Pre-existing disease, Rheumatoid arthritis — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Worsening of rheumatoid arthritis symptoms.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-16
- 2021-04-23
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2021-06-11
Survey response — 3 months, dose 2MedDRA: Chest pain, Cholelithiasis, Emergency care, Nephrolithiasis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Chest pain which sent me to ER. Had angiogram. Everything okay. Following week diagnosed with gallstones and sludge. Also diagnosed with large kidney stone lodged in ureter.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-11
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-06-17
Call successfulParticipant prefers to complete VAERS report online
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2021-09-10
Survey response — 6 months, dose 2MedDRA: Cholecystectomy — Feeling: Fair · Get care from a doctor or other healthcare professional · HospitalizationFree text: Had to have gallbladder removal.MedDRA releases: 2024-11 · check-in free text available
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2021-09-10
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-09-13
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
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2021-09-14
Dose 3 — Moderna
- 2022-03-12
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2022-04-22
Dose 4 — Moderna
- 2022-05-02
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-06-03
- 2022-07-22
- 2022-10-21
- 2023-04-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-03 | Moderna | |
| 2 | 2021-03-12 | Moderna | |
| 3 | 2021-09-14 | Moderna | No |
| 4 | 2022-04-22 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Late yesterday I had fever, headache, heart racing, and blood pressure shot way up. Lasted about 4-5 hours & was after I had done my daily check in.
Systemic reaction (other): Light headed, faint
Systemic reaction (other): Feel light headed and weak
Release 7 — day 28, dose 2
Symptoms: Worsening of rheumatoid arthritis symptoms.
Release 9 — 3 months, dose 2
Symptoms: Chest pain which sent me to ER. Had angiogram. Everything okay. Following week diagnosed with gallstones and sludge. Also diagnosed with large kidney stone lodged in ureter.
Release 9 — 6 months, dose 2
Symptoms: Had to have gallbladder removal.
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 | Chest pain | ✓ | ✓ | ✓ |
| SD | Cholecystectomy | · | · | ✓ |
| SD | Cholelithiasis | ✓ | ✓ | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Nephrolithiasis | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Rheumatoid arthritis | ✓ | ✓ | ✓ |
| SRO | Asthenia | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Hypertension | ✓ | ✓ | ✓ |
| SRO | Palpitations | ✓ | ✓ | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Syncope | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release