2V4-40967-90943
5 vaccinations
14 coded responses
49 check-ins
13 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 460 / IN
- Registered
- 2021-02-28
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-09
Dose 1 — Moderna
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2021-02-28
Registered in v-safe
- 2021-03-02
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2021-03-09
Dose 2 — Moderna
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-04-06
- 2021-04-13
- 2021-04-20
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2021-06-09
Survey response — 3 months, dose 2MedDRA: Abdominal pain upper, Flank pain, Hot flush, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Right side and lower stomach painHot Flashes · Healthcare visit (other): Doctor office visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-09
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-09-07
Survey response — 6 months, dose 2MedDRA: Chills, Fatigue, Oropharyngeal pain, Rhinorrhoea, Unevaluable event — Feeling: FairFree text: Tiredness, a slight runny nose, sometimes a few chills and a slight sore throat.Its probably my sinuses. Im feeling better today. The chills and the slight sore throat are gone.MedDRA releases: 2024-11 · check-in free text available
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2021-10-27
Dose 3 — Moderna
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2021-10-28
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Chills, Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Chills, Fatigue or tirednessAdult check-in
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2021-10-30
Survey response — days 1–6 daily, dose 3MedDRA: Pain in extremity — Feeling: Good · Site: PainFree text: My arm is just a little soreMedDRA releases: 2024-11 · check-in free text available
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2021-10-31
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2021-11-01
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2021-11-02
Survey response — days 1–6 daily, dose 3MedDRA: Cough — Feeling: Fair · Fatigue or tirednessFree text: CoughMedDRA releases: 2024-11 · check-in free text available
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2021-11-03
Survey response — day 7, dose 3MedDRA: Muscle spasms — Feeling: Good · Fatigue or tirednessFree text: Some leg crampsMedDRA releases: 2024-11 · check-in free text available
- 2021-11-11
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2021-11-17
Survey response — day 21, dose 3MedDRA: Back pain, Cough — Feeling: FairFree text: I have developed a irritating cough. I'm also having some lower back pain. I'm not sure if it's from the booster. I'm going to check with my doctor regarding the cough to see if it's from another condition I have.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-20
- 2021-11-24
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2021-12-01
Survey response — day 35, dose 3MedDRA: Cough — Feeling: FairFree text: I have a persistent cough.MedDRA releases: 2024-11 · check-in free text available
- 2021-12-08
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2022-01-26
Survey response — 3 months, dose 3MedDRA: Chills, Cough, Fatigue, Pain, Rhinorrhoea — Feeling: Good · 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 visitFree text: Runny nose, body aches, cough, chills, tirednessMedDRA releases: 2024-11 · check-in free text available
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2022-01-26
Report sent to call center — 3 months, dose 3Be 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)
- 2022-01-27
- 2022-04-28
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2022-07-15
Dose 4 — Moderna
- 2022-07-15
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2022-07-16
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Chills, Fatigue or tiredness, NauseaAdult check-in
- 2022-07-17
- 2022-07-18
- 2022-07-19
- 2022-07-20
- 2022-07-21
- 2022-07-22
- 2022-07-29
- 2022-08-05
- 2022-08-12
- 2022-08-21
- 2022-08-27
- 2022-10-15
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2022-11-30
Dose 5 — Moderna
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2022-12-03
Survey response — days 1–6 daily, dose 5MedDRA: Neck pain — Feeling: Fair · HeadacheFree text: Neck painMedDRA releases: 2024-11 · check-in free text available
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2022-12-04
Survey response — days 1–6 daily, dose 5MedDRA: Neck pain — Feeling: Fair · HeadacheFree text: Neck painMedDRA releases: 2024-11 · check-in free text available
- 2022-12-06
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2022-12-07
Survey response — day 7, dose 5MedDRA: Headache, Neck pain — Feeling: Fair · HeadacheFree text: Neck/head painMedDRA releases: 2024-11 · check-in free text available
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2022-12-14
Survey response — day 14, dose 5MedDRA: Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Numbness & tingling left side of face, lips & armMedDRA releases: 2024-11 · check-in free text available
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2022-12-14
Report sent to call center — day 14, dose 5Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2022-12-15
- 2022-12-15
- 2022-12-15
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2022-12-15
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-12-15
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-12-15
Call successfulCompleted over the phone
- 2022-12-22
- 2022-12-28
- 2023-01-04
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2023-01-11
Survey response — day 42, dose 5MedDRA: Neck pain, Office visit, Pain in extremity — Feeling: Fair · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
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2023-01-11
Report sent to call center — day 42, dose 5Get care from a doctor or other healthcare professional1 call case(s)
- 2023-01-12
- 2023-03-01
- 2023-06-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-09 | Moderna | |
| 2 | 2021-03-09 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-07-15 | Moderna | No |
| 5 | 2022-11-30 | Moderna | No |
Call center
4 call center cases
3 successful · 1 unsuccessful
VAERS report filed, before or during a call: 1
1 wait over 3 months for a first call
Free text
Release 9 — 3 months, dose 2
Symptoms: Right side and lower stomach painHot Flashes
Healthcare visit (other): Doctor office visit
Release 9 — 6 months, dose 2
Symptoms: Tiredness, a slight runny nose, sometimes a few chills and a slight sore throat.Its probably my sinuses. Im feeling better today. The chills and the slight sore throat are gone.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): My arm is just a little sore
Systemic reaction (other): No
Systemic reaction (other): Cough
Release 10 — day 7, dose 3
Systemic reaction (other): Some leg cramps
Release 10 — day 21, dose 3
Symptoms: I have developed a irritating cough. I'm also having some lower back pain. I'm not sure if it's from the booster. I'm going to check with my doctor regarding the cough to see if it's from another condition I have.
Release 10 — day 35, dose 3
Symptoms: I have a persistent cough.
Release 11 — 3 months, dose 3
Symptoms: Runny nose, body aches, cough, chills, tiredness
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Neck pain
Systemic reaction (other): Neck pain
Release 12 — day 7, dose 5
Systemic reaction (other): Neck/head pain
Release 12 — day 14, dose 5
Symptoms: Numbness & tingling left side of face, lips & arm
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 | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Back pain | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Flank pain | ✓ | ✓ | ✓ |
| SD | Hot flush | ✓ | ✓ | ✓ |
| SD | Hypoaesthesia | · | · | ✓ |
| SD | Hypoaesthesia oral | · | · | ✓ |
| SD | Neck pain | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Paraesthesia | · | · | ✓ |
| SD | Paraesthesia oral | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Cough | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Muscle spasms | · | · | ✓ |
| SRO | Neck pain | · | · | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release