3H6-15612-62765
5 vaccinations
16 coded responses
63 check-ins
15 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 480 / MI
- Registered
- 2021-01-29
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-01-29
Registered in v-safe
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2021-01-29
Dose 1 — Moderna
- 2021-01-29
- 2021-01-31
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2021-02-01
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: Pain · Muscle or body achesFree text: Mild pain at injection site which is dissipating dailyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-02
Survey response — days 1–6 daily, dose 1MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain, Redness, Itching · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-03
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Redness, Itching · Headache, Fatigue or tirednessAdult check-in
- 2021-02-04
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2021-02-05
Survey response — day 7, dose 1MedDRA: Unevaluable event — Feeling: Fair · Headache, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesFree text: May be from bad food.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-12
Survey response — day 14, dose 1MedDRA: Fatigue, Injection site erythema, Injection site pain, Injection site warmth, Office visit — 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: Left arm near injection all the way to elbow, bright red and very hot to the touch. About 6 in diameter. Arm muscle sore. Periodic fatigue. Dr. prescribed prescription anti-histamine 02/09/21. Improving. Dr. re-eval. 2/19 for 2nd vaccine 2/26MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-12
Report sent to call center — day 14, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-19
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2021-02-26
Dose 2 — Moderna
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2021-02-26
Survey response — day 0, dose 2MedDRA: Dysgeusia, Feeling abnormal, Oral discomfort, Tongue discomfort — Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessFree text: Food tastes weird. Mouth, lips, tongue feel weird.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-27
Survey response — days 1–6 daily, dose 2MedDRA: Pain in extremity — Feeling: Poor · Site: Pain, Swelling · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesFree text: Really sore arm.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-03-01
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness, Diarrhea, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
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2021-03-02
Survey response — days 1–6 daily, dose 2MedDRA: Gastroenteritis viral — Feeling: Fair · Site: Pain, Swelling, Itching · Headache, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesFree text: Intestinal flu like symptoms slowly improvingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-03
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-03-04
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-03-05
- 2021-03-12
- 2021-03-19
- 2021-03-26
- 2021-04-02
- 2021-04-11
- 2021-05-28
- 2021-07-30
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2021-07-30
Call successfulParticipant prefers to complete VAERS report online
- 2021-08-27
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2021-11-17
Dose 3 — Moderna
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2021-11-20
Survey response — days 1–6 daily, dose 3MedDRA: Oropharyngeal pain — Feeling: Poor · Site: Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesFree text: Sore throatMedDRA releases: 2024-11 · check-in free text available
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2021-11-21
Survey response — days 1–6 daily, dose 3MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Swelling, Itching · Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesFree text: Sore throatMedDRA releases: 2024-11 · check-in free text available
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2021-11-22
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: Fair · Site: Swelling, Itching · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2021-11-23
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Itching · Muscle or body achesAdult check-in
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2021-12-15
- 2021-12-22
- 2021-12-29
- 2022-02-16
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2022-04-19
Dose 4 — Moderna
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2022-04-19
Survey response — day 0, dose 4MedDRA: Feeling abnormal, Injection site pain — Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesFree text: Overall yucky. Sore arm at sight of shot.MedDRA releases: 2024-11 · check-in free text available
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2022-04-20
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-04-21
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2022-04-22
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2022-04-23
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Redness, Swelling · Muscle or body achesAdult check-in
- 2022-04-24
- 2022-04-25
- 2022-04-26
- 2022-05-03
- 2022-05-10
- 2022-05-19
- 2022-05-24
- 2022-05-31
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2022-07-19
Survey response — 3 months, dose 4MedDRA: Abdominal discomfort, Fatigue, Headache, Oropharyngeal pain, Respiratory tract congestion — Feeling: Fair · 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: Congestion. Sore throat, headache, intestinal upset, some fatigue. No fever.MedDRA releases: 2024-11 · check-in free text available
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2022-07-19
Report sent to call center — 3 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 · 1 call case(s)
- 2022-07-20
- 2022-07-20
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2022-07-20
Call successfulNot applicable - Accidental Reporting
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2022-10-06
Dose 5 — Moderna
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2022-10-07
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain · Headache, Muscle or body achesAdult check-in
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2022-10-08
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
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2022-10-09
Survey response — days 1–6 daily, dose 5MedDRA: Dyspnoea — Feeling: Good · Site: PainFree text: Short of breathMedDRA releases: 2024-11 · check-in free text available
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2022-10-10
Survey response — days 1–6 daily, dose 5MedDRA: Chest discomfort, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Systemic reaction (other): Tightness in chest. · Healthcare visit (other): Positive PCR. EKG.MedDRA releases: 2024-11 · check-in free text available
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2022-10-10
Report sent to call center — days 1–6 daily, dose 5Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-10-11
Survey response — days 1–6 daily, dose 5MedDRA: Laboratory test abnormal — Feeling: Fair · Fatigue or tirednessFree text: Tested positive pcr 10/9/22. Retested 10/10/22 pcr negative, 10/11 rapid negativeMedDRA releases: 2024-11 · check-in free text available
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2022-10-11
Call successfulDoes not wish to fill out VAERS report
- 2022-10-12
- 2022-10-13
- 2022-10-20
- 2022-10-27
- 2022-11-03
- 2022-11-10
- 2022-11-18
- 2023-01-05
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2023-04-08
Survey response — 6 months, dose 5MedDRA: Hospitalisation, Pneumonia, Viral infection — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationMedDRA releases: 2024-11
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2023-04-08
Report sent to call center — 6 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
- 2023-04-10
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-29 | Moderna | |
| 2 | 2021-02-26 | Moderna | |
| 3 | 2021-11-17 | Moderna | No |
| 4 | 2022-04-19 | Moderna | No |
| 5 | 2022-10-06 | Moderna | No |
Call center
4 call center cases
3 successful · 1 unsuccessful
1 wait over 3 months for a first call
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Mild pain at injection site which is dissipating daily
Systemic reaction (other): Sore throat
Release 3 — day 7, dose 1
Systemic reaction (other): May be from bad food.
Release 4 — day 14, dose 1
Symptoms: Left arm near injection all the way to elbow, bright red and very hot to the touch. About 6 in diameter. Arm muscle sore. Periodic fatigue. Dr. prescribed prescription anti-histamine 02/09/21. Improving. Dr. re-eval. 2/19 for 2nd vaccine 2/26
Release 4 — day 0, dose 2
Systemic reaction (other): Food tastes weird. Mouth, lips, tongue feel weird.
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Really sore arm.
Systemic reaction (other): Intestinal flu like symptoms slowly improving
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Sore throat
Systemic reaction (other): Sore throat
Systemic reaction (other): No
Release 11 — day 0, dose 4
Systemic reaction (other): Overall yucky. Sore arm at sight of shot.
Release 12 — 3 months, dose 4
Symptoms: Congestion. Sore throat, headache, intestinal upset, some fatigue. No fever.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Short of breath
Systemic reaction (other): Tightness in chest.
Healthcare visit (other): Positive PCR. EKG.
Systemic reaction (other): Tested positive pcr 10/9/22. Retested 10/10/22 pcr negative, 10/11 rapid negative
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 | Unevaluable event | · | · | ✓ |
| SD | Abdominal discomfort | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Injection site erythema | ✓ | ✓ | ✓ |
| SD | Injection site pain | ✓ | ✓ | ✓ |
| SD | Injection site warmth | ✓ | ✓ | ✓ |
| SD | Office visit | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pneumonia | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Viral infection | · | · | ✓ |
| SRO | Chest discomfort | · | · | ✓ |
| SRO | Dysgeusia | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | · | · | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | Gastroenteritis viral | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Laboratory test abnormal | · | · | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Oral discomfort | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Tongue discomfort | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release