2VJ-27255-42427
4 vaccinations
7 coded responses
47 check-ins
7 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 376 / TN
- Registered
- 2021-01-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-04
Registered in v-safe
-
2021-01-04
Dose 1 — Moderna
-
2021-01-04
Survey response — day 0, dose 1MedDRA: Dizziness, Immediate post-injection reaction — Feeling: GoodFree text: Approximately 60 minutes after receiving vaccine I experienced a slight feeling of lightheadedness. It lasted approximately 2 hours. Sensation disappeared and currently feel normal.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-06
-
2021-01-07
Survey response — days 1–6 daily, dose 1MedDRA: Adverse reaction — Feeling: Good · Joint pains, DiarrheaFree text: All symptoms are mild and not unusual for me.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-08
-
2021-01-09
Survey response — days 1–6 daily, dose 1MedDRA: Discomfort, Emergency care, Muscle spasms, Musculoskeletal pain, Office visit — Feeling: Good · Joint pains · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: At 1 AM I experienced a sudden onset pain in the area of my right scapula. It was uncomfortable enough that I felt I probably wasn't going to get much sleep. After an hour of trying to find a comfortable I took one naproxen. In 30 minutes the pain went away. My wife insisted In the morning that I go to urgent care or the emergency room because she discovered that it could be symptomatic of a heart issue. I went to urgent care who told me to go to the emergency room. The emergency room doctor diagnosed my experience as being a muscle spasm And prescribed a muscle relaxer. As of this time the pain has not returned and since it is the opposite shoulder of the arm in which I received the vaccinationI doubt that he had any connection to the vaccination.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-09
Report sent to call center — days 1–6 daily, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-01-10
- 2021-01-13
- 2021-01-21
- 2021-01-25
-
2021-02-01
Dose 2 — Moderna
- 2021-02-01
- 2021-02-02
-
2021-02-03
Survey response — days 1–6 daily, dose 2MedDRA: Discomfort, Muscle spasms, Pain — Feeling: Good · Muscle or body achesFree text: 72 hours After shot #1 experienced significant pain near right scapula diagnosed at ER as muscle spasm. 48 hours after shot #2 had mild pain/discomfort in exactly same area. Both quickly resolved with Naproxen.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-15
- 2021-02-17
-
2021-02-17
Call successfulDoes not wish to fill out VAERS report
- 2021-02-22
- 2021-03-01
-
2021-03-08
Survey response — day 35, dose 2MedDRA: Application site erythema, Application site pruritus, Skin reaction — Feeling: GoodFree text: Adverse skin reaction to prescribed Nystatin powder, extreme reddening and itching of application site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-15
- 2021-05-03
- 2021-08-02
-
2021-10-26
Dose 3 — Moderna
- 2021-10-26
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-09
- 2021-11-16
- 2021-11-23
-
2021-11-30
Survey response — day 35, dose 3MedDRA: Chest pain, Cough, Rhinorrhoea — Feeling: FairFree text: A day of much more coughing than usual. Following morning coughing caused a mildly painful feeling in my chest and greater runny nose. Treated by inhaling warm moist air from hot drinks . Symptoms much better today. No fever or other symptoms.MedDRA releases: 2024-11 · check-in free text available
-
2021-12-07
Survey response — day 42, dose 3MedDRA: Dyspnoea — Feeling: Good · Be unable to do your normal daily activitiesFree text: One day of severe shortness of breath that is much better within 24 hours.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-25
-
2022-04-12
Dose 4 — Moderna
- 2022-04-20
- 2022-04-26
- 2022-05-03
- 2022-05-10
- 2022-05-17
- 2022-05-24
- 2022-07-12
- 2022-10-11
- 2023-04-12
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-04 | Moderna | |
| 2 | 2021-02-01 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-04-12 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 1 — day 0, dose 1
Systemic reaction (other): Approximately 60 minutes after receiving vaccine I experienced a slight feeling of lightheadedness. It lasted approximately 2 hours. Sensation disappeared and currently feel normal.
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): All symptoms are mild and not unusual for me.
Healthcare visit (other): At 1 AM I experienced a sudden onset pain in the area of my right scapula. It was uncomfortable enough that I felt I probably wasn't going to get much sleep. After an hour of trying to find a comfortable I took one naproxen. In 30 minutes the pain went away. My wife insisted In the morning that I go to urgent care or the emergency room because she discovered that it could be symptomatic of a heart issue. I went to urgent care who told me to go to the emergency room. The emergency room doctor diagnosed my experience as being a muscle spasm And prescribed a muscle relaxer. As of this time the pain has not returned and since it is the opposite shoulder of the arm in which I received the vaccinationI doubt that he had any connection to the vaccination.
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): 72 hours After shot #1 experienced significant pain near right scapula diagnosed at ER as muscle spasm. 48 hours after shot #2 had mild pain/discomfort in exactly same area. Both quickly resolved with Naproxen.
Release 5 — day 35, dose 2
Symptoms: Adverse skin reaction to prescribed Nystatin powder, extreme reddening and itching of application site.
Release 10 — day 35, dose 3
Symptoms: A day of much more coughing than usual. Following morning coughing caused a mildly painful feeling in my chest and greater runny nose. Treated by inhaling warm moist air from hot drinks . Symptoms much better today. No fever or other symptoms.
Release 10 — day 42, dose 3
Symptoms: One day of severe shortness of breath that is much better within 24 hours.
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 | Discomfort | ✓ | ✓ | ✓ |
| HCVO | Emergency care | ✓ | ✓ | ✓ |
| HCVO | Muscle spasms | ✓ | ✓ | ✓ |
| HCVO | Musculoskeletal pain | ✓ | ✓ | ✓ |
| HCVO | Office visit | ✓ | ✓ | ✓ |
| SD | Application site erythema | ✓ | ✓ | ✓ |
| SD | Application site pruritus | ✓ | ✓ | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Skin reaction | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Discomfort | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SRO | Muscle spasms | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ○ | ○ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release