2UK-11456-99700
2 vaccinations
2 coded responses
24 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 613 / IL
- Registered
- 2020-12-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-24
Registered in v-safe
-
2020-12-24
Dose 1 — Moderna
-
2020-12-26
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2020-12-27
- 2020-12-28
- 2020-12-30
- 2020-12-31
- 2021-01-07
- 2021-01-14
-
2021-01-21
Dose 2 — Moderna
- 2021-01-21
- 2021-01-21
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-02-04
- 2021-02-11
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-04-22
-
2021-07-22
Survey response — 6 months, dose 2MedDRA: Chest pain, Infection, Lower respiratory tract infection, Nasal discomfort — Feeling: GoodFree text: Nasal infection that burnt. Ive had this for years. Dropped to my chest. No I did not get tested for COVID. Lasted about 6 days.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-21
Survey response — 12 months, dose 2MedDRA: Arthralgia, Back pain, Blindness unilateral, Emergency care, Office visit, Retinal artery occlusion — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Loss of vision in my right eye my main artery in my optic nerve suffered a stroke and they do not know why. Also since my booster I had lower back pain for two months and my knees hurt really bad I am all through with that now though · Healthcare visit (other): I had to go to Gailey eye two visit and I had to go to the hospital and have a Steroid infusion three days in a row also had had blood work doneMedDRA releases: 2024-11 · check-in free text available
-
2022-01-21
Report sent to call center — 12 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2022-01-25
- 2022-01-26
-
2022-01-28
Callback requested for05:00PM CT
-
2022-01-28
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-24 | Moderna | |
| 2 | 2021-01-21 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 9 — 6 months, dose 2
Symptoms: Nasal infection that burnt. Ive had this for years. Dropped to my chest. No I did not get tested for COVID. Lasted about 6 days.
Release 11 — 12 months, dose 2
Symptoms: Loss of vision in my right eye my main artery in my optic nerve suffered a stroke and they do not know why. Also since my booster I had lower back pain for two months and my knees hurt really bad I am all through with that now though
Healthcare visit (other): I had to go to Gailey eye two visit and I had to go to the hospital and have a Steroid infusion three days in a row also had had blood work done
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 | Emergency care | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Back pain | · | · | ✓ |
| SD | Blindness unilateral | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Infection | · | · | ✓ |
| SD | Lower respiratory tract infection | · | · | ✓ |
| SD | Nasal discomfort | · | · | ✓ |
| SD | Retinal artery occlusion | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release