2CH-13902-58852
5 vaccinations
6 coded responses
32 check-ins
4 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 600 / IL
- Registered
- 2021-01-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-30
Registered in v-safe
-
2021-01-30
Dose 1 — Moderna
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-13
- 2021-02-20
-
2021-02-23
Dose 2 — Moderna
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-04-06
-
2021-05-25
Survey response — 3 months, dose 2MedDRA: Balance disorder, Fall, Office visit — Feeling: Poor · Get care from a doctor or other healthcare professionalFree text: Symptoms: Balance problems causing unexpected falling · Healthcare visit (other): Doctor visit in office followed by MRIMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-25
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-24
-
2021-11-02
Dose 3 — Moderna
- 2022-02-23
-
2022-05-03
Survey response — 6 months, dose 3MedDRA: COVID-19, Quarantine — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: I had a mild case of Covid and took antiviral medication and quarantined for 5 days.MedDRA releases: 2024-11 · check-in free text available
-
2022-05-06
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-07-12
Dose 4 — Moderna
-
2022-10-14
Dose 5 — Moderna
- 2022-10-20
- 2022-10-21
- 2022-10-28
- 2022-11-04
- 2022-11-11
-
2022-11-18
Survey response — day 35, dose 5MedDRA: COVID-19, SARS-CoV-2 test positive — Feeling: Poor · 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: Diagnosed with Covid by a PCR test. An taking an alternative antiviral to Paxlovid. I had my recent booster 1 month ago in October. Probably QB1 or QB1.1 variantMedDRA releases: 2024-11 · check-in free text available
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2022-11-18
Report sent to call center — day 35, 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)
-
2022-11-21
Call successfulParticipant prefers to complete VAERS report online
-
2022-11-25
Survey response — day 42, dose 5MedDRA: COVID-19 — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: I contracted Covid last week and this week I was diagnosed with rebound CovidMedDRA releases: 2024-11 · check-in free text available
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2022-11-25
Report sent to call center — day 42, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
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2022-11-28
Call successfulReported to VAERS voluntarily prior to GDIT contact
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2023-01-13
Survey response — 3 months, dose 5MedDRA: COVID-19, Office visit, Sinusitis — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-01-13
Report sent to call center — 3 months, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2023-01-17
Call successfulReported to VAERS voluntarily prior to GDIT contact
-
2023-04-14
Survey response — 6 months, dose 5MedDRA: COVID-19 — Feeling: Good · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-30 | Moderna | |
| 2 | 2021-02-23 | Moderna | |
| 3 | 2021-11-02 | Moderna | No |
| 4 | 2022-07-12 | Moderna | No |
| 5 | 2022-10-14 | Moderna | No |
Call center
4 call center cases
4 successful
VAERS report filed, before or during a call: 2
Free text
Release 8 — 3 months, dose 2
Symptoms: Balance problems causing unexpected falling
Healthcare visit (other): Doctor visit in office followed by MRI
Release 11 — 6 months, dose 3
Symptoms: I had a mild case of Covid and took antiviral medication and quarantined for 5 days.
Release 12 — day 35, dose 5
Symptoms: Diagnosed with Covid by a PCR test. An taking an alternative antiviral to Paxlovid. I had my recent booster 1 month ago in October. Probably QB1 or QB1.1 variant
Release 12 — day 42, dose 5
Symptoms: I contracted Covid last week and this week I was diagnosed with rebound Covid
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 | Balance disorder | ✓ | ✓ | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Fall | ✓ | ✓ | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Quarantine | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release