3ST-17040-27411
4 vaccinations
4 coded responses
54 check-ins
3 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 199 / DE
- Registered
- 2021-01-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-30
Registered in v-safe
-
2021-01-30
Dose 1 — Moderna
-
2021-01-30
Survey response — day 0, dose 1MedDRA: No adverse event — Feeling: GoodFree text: Nothing yet - just got the vaccine 5 hours ago.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-13
- 2021-02-20
- 2021-02-27
-
2021-02-28
Dose 2 — Moderna
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-07
- 2021-03-14
- 2021-03-21
- 2021-03-28
- 2021-04-04
- 2021-04-11
- 2021-05-30
- 2021-08-29
-
2021-10-27
Dose 3 — Moderna
- 2021-10-27
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-12
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
-
2022-01-26
Survey response — 3 months, dose 3MedDRA: Gastrointestinal haemorrhage, Haemoglobin decreased, Office visit, Telemedicine, Transfusion, Ulcer haemorrhage — Feeling: Good · 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: Symptoms: GI bleed probably from bleeding ulcer - having an endoscopy soon. Hemoglobin dropped & required a transfusion. Feeling better now. · Healthcare visit (other): Office visit with PCP, Telehealth visit with GI doctor.MedDRA releases: 2024-11 · check-in free text available
-
2022-01-26
Report sent to call center — 3 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-01-28
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-04-26
Dose 4 — Moderna
- 2022-04-27
- 2022-04-28
- 2022-04-29
- 2022-04-30
- 2022-05-01
- 2022-05-02
- 2022-05-03
- 2022-05-10
- 2022-05-20
- 2022-05-24
- 2022-05-31
- 2022-06-07
-
2022-07-26
Survey response — 3 months, dose 4MedDRA: Atrial fibrillation, Cardioversion, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Atrial fibrillation - had cardioversion & currently in normal sinus rhythm · Healthcare visit (other): Same day treatment by cardiologist - TEE (transesphageal echocardiography) and cardioversion.MedDRA releases: 2024-11 · check-in free text available
-
2022-07-26
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-07-27
- 2022-07-27
- 2022-08-03
- 2022-08-03
-
2022-08-03
Callback requested for09:00AM ET
-
2022-08-03
Call successfulDoes not wish to fill out VAERS report
- 2022-10-25
-
2023-04-26
Survey response — 12 months, dose 4MedDRA: Atrial fibrillation, Cardioversion, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
-
2023-04-26
Report sent to call center — 12 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
-
2023-04-27
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 | 2021-01-30 | Moderna | |
| 2 | 2021-02-28 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-04-26 | Moderna | No |
Call center
3 call center cases
3 successful
1 wait over 3 months for a first call
Free text
Release 3 — day 0, dose 1
Systemic reaction (other): Nothing yet - just got the vaccine 5 hours ago.
Release 11 — 3 months, dose 3
Symptoms: GI bleed probably from bleeding ulcer - having an endoscopy soon. Hemoglobin dropped & required a transfusion. Feeling better now.
Healthcare visit (other): Office visit with PCP, Telehealth visit with GI doctor.
Release 12 — 3 months, dose 4
Symptoms: Atrial fibrillation - had cardioversion & currently in normal sinus rhythm
Healthcare visit (other): Same day treatment by cardiologist - TEE (transesphageal echocardiography) and cardioversion.
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 | Cardioversion | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| HCVO | Telemedicine | · | · | ✓ |
| SD | Atrial fibrillation | · | · | ✓ |
| SD | Cardioversion | · | · | ✓ |
| SD | Gastrointestinal haemorrhage | · | · | ✓ |
| SD | Haemoglobin decreased | · | · | ✓ |
| SD | Transfusion | · | · | ✓ |
| SD | Ulcer haemorrhage | · | · | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release