2M9-30431-43116
1 vaccination
6 coded responses
14 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 054 / VT
- Registered
- 2022-06-30
- Relationship
- Child or adolescent in my care
- Guardian
- 2YN-10907-67406
- Race
- Multiracial
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-30
Registered in v-safe
-
2022-06-30
Dose 1 — Moderna
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2022-06-30
Survey response — day 0, dose 1, dependentMedDRA: Diabetes mellitus, Hyperglycaemic crisis, Pre-existing disease — Feeling: GoodFree text: (b)(6) has type 1 diabetes mellitus juvenile & his BG has been harder to manage, hyperglycemic & in need of increased insulin dosages.MedDRA releases: 2024-11 · check-in free text available
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2022-07-01
Survey response — days 1–6 daily, dose 1, dependentMedDRA: Hyperglycaemia — Feeling: Fair · Fever · Fatigue or tiredness, Vomiting, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: HyperglycemiaMedDRA releases: 2024-11 · check-in free text available
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2022-07-03
Survey response — days 1–6 daily, dose 1, dependentMedDRA: Hyperglycaemia — Feeling: Fair · Fatigue or tirednessFree text: HyperglycemiaMedDRA releases: 2024-11 · check-in free text available
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2022-07-04
Survey response — days 1–6 daily, dose 1, dependentMedDRA: Hyperglycaemia — Feeling: GoodFree text: Continued hyperglycemiaMedDRA releases: 2024-11 · check-in free text available
- 2022-07-05
- 2022-07-06
- 2022-07-07
- 2022-07-15
- 2022-07-21
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2022-07-28
Survey response — day 28, dose 1, dependentMedDRA: Diarrhoea, Hypoglycaemia, Vomiting — 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 · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, HospitalizationFree text: Vomiting, diarrhea, & hypoglycemia.MedDRA releases: 2024-11 · check-in free text available
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2022-07-28
Report sent to call center — day 28, dose 1, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
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2022-07-29
Call successfulParticipant prefers to complete VAERS report online
- 2022-08-04
- 2022-08-11
- 2022-09-29
-
2022-12-29
Survey response — 6 months, dose 1, dependentMedDRA: Cough, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Runny nose, coughMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-06-30 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-07-28 | Successful 2022-07-29 |
Participant prefers to complete VAERS report online |
Free text
Release 12 — day 0, dose 1, dependent
Systemic reaction (other): (b)(6) has type 1 diabetes mellitus juvenile & his BG has been harder to manage, hyperglycemic & in need of increased insulin dosages.
redacted (b)(6)
Release 12 — days 1–6 daily, dose 1, dependent
Systemic reaction (other): Hyperglycemia
Systemic reaction (other): Hyperglycemia
Systemic reaction (other): Continued hyperglycemia
Release 12 — day 28, dose 1, dependent
Symptoms: Vomiting, diarrhea, & hypoglycemia.
Release 12 — 6 months, dose 1, dependent
Symptoms: Runny nose, cough
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 | Cough | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Hypoglycaemia | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
| SRO | Diabetes mellitus | · | · | ✓ |
| SRO | Hyperglycaemia | · | · | ✓ |
| SRO | Hyperglycaemic crisis | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release