3CA-16791-23486
4 vaccinations
9 coded responses
29 check-ins
9 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 857 / AZ
- Registered
- 2021-02-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-03
Registered in v-safe
-
2021-02-03
Dose 1 — Moderna
- 2021-02-03
- 2021-02-04
- 2021-02-05
-
2021-02-06
Health check-in — days 1–6 daily, dose 1Feeling: Good · Fatigue or tiredness, Diarrhea, Abdominal painAdult check-in
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-17
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2021-02-24
Survey response — day 21, dose 1MedDRA: Injection site pruritus, Injection site rash, Vaccination site pain — Feeling: GoodFree text: Day 13 I got a rash at vaccination site. Day 14 it hurt and day 115 and 16 it itched. It lasted 5 days. It is now pretty much disappeared but Im concerned that this hypersensitivity will be worse with second vaccination. Please advise.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-03
-
2021-03-04
Dose 2 — Moderna
- 2021-03-04
-
2021-03-05
Survey response — days 1–6 daily, dose 2MedDRA: Renal pain — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to workFree text: Painful kidneysMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-06
Survey response — days 1–6 daily, dose 2MedDRA: Renal pain — Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tiredness, Abdominal pain · Be unable to workFree text: Kidneys really hurtMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-07
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-08
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-09
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-10
- 2021-03-11
- 2021-03-18
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2021-03-25
Survey response — day 21, dose 2MedDRA: Abdominal pain upper — Feeling: GoodFree text: Pancreas painMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-01
Survey response — day 28, dose 2MedDRA: Cough, Feeling abnormal — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Cough. Fuzzy headedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-08
Survey response — day 35, dose 2MedDRA: Cough, Fatigue — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Fatigue. Cough.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-08
Report sent to call center — day 35, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-15
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2021-06-03
Survey response — 3 months, dose 2MedDRA: Iron deficiency — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Iron deficiency.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-03
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-08-25
Dose 3 — Moderna
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2021-09-02
Survey response — 6 months, dose 2MedDRA: Adverse reaction, Office visit, Platelet count decreased, Pre-existing disease, Reaction to previous exposure to any vaccine — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Had my booster because Im immune compromised and reacted poorly with all the same symptoms of second. PLUS my platelets dropped from 54 to 17 placing me in a dangerous situation. Thankfully Id been having blood drawn regularly and doc caught it · Healthcare visit (other): Hematologist/OncologistMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-09-02
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-03
- 2021-09-07
-
2021-09-07
Call successfulCompleted over the phone
-
2021-10-29
Dose 4 — Janssen/Johnson & Johnson
- 2022-03-04
- 2022-04-29
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2022-10-29
Survey response — 12 months, dose 4MedDRA: Cough, Fall, Gastrointestinal disorder, Oral herpes, Thoracic vertebral fracture, Vertigo — 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 visit, Emergency room or emergency department visitFree text: Cold sores, cough since February: abdominal issues; vertigo wit fall, fractured T-10MedDRA releases: 2024-11 · check-in free text available
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2022-10-29
Report sent to call center — 12 months, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
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2022-10-31
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-03 | Moderna | |
| 2 | 2021-03-04 | Moderna | |
| 3 | 2021-08-25 | Moderna | No |
| 4 | 2021-10-29 | Janssen/Johnson & Johnson | No |
Call center
4 call center cases
4 successful
VAERS report filed, before or during a call: 3
Free text
Release 4 — day 21, dose 1
Symptoms: Day 13 I got a rash at vaccination site. Day 14 it hurt and day 115 and 16 it itched. It lasted 5 days. It is now pretty much disappeared but Im concerned that this hypersensitivity will be worse with second vaccination. Please advise.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Painful kidneys
Systemic reaction (other): Kidneys really hurt
Release 6 — day 21, dose 2
Symptoms: Pancreas pain
Release 6 — day 28, dose 2
Symptoms: Cough. Fuzzy headed
Release 7 — day 35, dose 2
Symptoms: Fatigue. Cough.
Release 8 — 3 months, dose 2
Symptoms: Iron deficiency.
Release 9 — 6 months, dose 2
Symptoms: Had my booster because Im immune compromised and reacted poorly with all the same symptoms of second. PLUS my platelets dropped from 54 to 17 placing me in a dangerous situation. Thankfully Id been having blood drawn regularly and doc caught it
Healthcare visit (other): Hematologist/Oncologist
Release 12 — 12 months, dose 4
Symptoms: Cold sores, cough since February: abdominal issues; vertigo wit fall, fractured T-10
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 | Adverse reaction | ✓ | · | ✓ |
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Fall | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Feeling abnormal | ✓ | ✓ | ✓ |
| SD | Gastrointestinal disorder | · | · | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SD | Iron deficiency | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | · | ✓ |
| SD | Oral herpes | · | · | ✓ |
| SD | Platelet count decreased | ✓ | · | ✓ |
| SD | Pre-existing disease | ✓ | · | ✓ |
| SD | Reaction to previous exposure to any vaccine | ✓ | · | ✓ |
| SD | Thoracic vertebral fracture | · | · | ✓ |
| SD | Vaccination site pain | ✓ | ✓ | ✓ |
| SD | Vertigo | · | · | ✓ |
| SRO | Renal pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release