38Q-26651-78861
5 vaccinations
5 coded responses
58 check-ins
5 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 073 / NJ
- Registered
- 2021-02-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-04
Registered in v-safe
-
2021-02-04
Dose 1 — Moderna
- 2021-02-04
- 2021-02-05
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-11
- 2021-02-18
- 2021-02-25
- 2021-03-04
-
2021-03-05
Dose 2 — Moderna
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-19
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-06-04
-
2021-09-03
Survey response — 6 months, dose 2MedDRA: Catheterisation cardiac abnormal, Stent placement — Feeling: Good · Get care from a doctor or other healthcare professional · HospitalizationFree text: Cardiac catheterization to install a stent. Suspect this is unrelated to vaccine.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-09-03
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-09
-
2021-09-09
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-10-29
Dose 3 — Moderna
- 2021-10-29
-
2021-10-30
Survey response — days 1–6 daily, dose 3MedDRA: Hyperhidrosis — Feeling: Good · Fever · ChillsFree text: Drenching sweatMedDRA releases: 2024-11 · check-in free text available
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2022-01-28
-
2022-03-30
Dose 4 — Moderna
- 2022-04-29
- 2022-04-29
-
2022-05-04
Survey response — day 35, dose 4MedDRA: Cough, Headache, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Congested, headache, runny nose and cough. Had negative COVID PCR test 5/2/22.MedDRA releases: 2024-11 · check-in free text available
-
2022-05-13
Survey response — day 42, dose 4MedDRA: Influenza, Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activitiesFree text: Ten day cold or flu. 3 negative COVID tests including 1 PCR.MedDRA releases: 2024-11 · check-in free text available
- 2022-06-29
-
2022-09-21
Dose 5 — Moderna
- 2022-09-21
- 2022-09-22
- 2022-09-24
- 2022-09-25
- 2022-09-26
- 2022-09-27
- 2022-09-28
- 2022-10-05
- 2022-10-12
- 2022-10-19
- 2022-10-26
- 2022-11-02
-
2022-12-21
Survey response — 3 months, dose 5MedDRA: COVID-19, Nasopharyngitis, Office visit, Respiratory tract congestion, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Good · 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: Bad cold on Nov 18th, took home COVID test on 20th which was positive, went to urgentcare and COVID confirmed. By 24th tested negative. Mild congestion persisted for two weeks. Then back to normal.MedDRA releases: 2024-11 · check-in free text available
-
2022-12-21
Report sent to call center — 3 months, 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)
-
2022-12-22
Call successfulParticipant prefers to complete VAERS report online
- 2023-03-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Moderna | |
| 2 | 2021-03-05 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-03-30 | Moderna | No |
| 5 | 2022-09-21 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 9 — 6 months, dose 2
Symptoms: Cardiac catheterization to install a stent. Suspect this is unrelated to vaccine.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Drenching sweat
Release 11 — day 35, dose 4
Symptoms: Congested, headache, runny nose and cough. Had negative COVID PCR test 5/2/22.
Release 11 — day 42, dose 4
Symptoms: Ten day cold or flu. 3 negative COVID tests including 1 PCR.
Release 12 — 3 months, dose 5
Symptoms: Bad cold on Nov 18th, took home COVID test on 20th which was positive, went to urgentcare and COVID confirmed. By 24th tested negative. Mild congestion persisted for two weeks. Then back to normal.
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 | Catheterisation cardiac abnormal | ✓ | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Stent placement | ✓ | · | ✓ |
| SRO | Hyperhidrosis | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release