3Y7-63804-01034
5 vaccinations
14 coded responses
65 check-ins
12 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 61-65
- ZIP prefix
- 201 / VA
- Registered
- 2021-03-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-13
Dose 1 — Moderna
-
2021-03-16
Registered in v-safe
- 2021-03-16
- 2021-03-17
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2021-03-18
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: GoodFree text: I didnt start vsafe until a few days after my injection. Just wanted to get it on record the only symptom Ive had was slight pain at injection site on the day after. But nothing since.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-19
- 2021-03-20
- 2021-03-27
- 2021-04-03
- 2021-04-10
-
2021-04-13
Dose 2 — Moderna
- 2021-04-13
-
2021-04-14
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-04-15
- 2021-04-16
- 2021-04-17
- 2021-04-18
- 2021-04-19
- 2021-04-20
-
2021-04-29
Survey response — day 14, dose 2MedDRA: Constipation, Lethargy — Feeling: FairFree text: Constipation, lethargy.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-04
- 2021-05-11
- 2021-05-18
- 2021-05-25
- 2021-07-13
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2021-10-12
Survey response — 6 months, dose 2MedDRA: Asthenia, Dizziness, Vomiting — Feeling: Good · Be unable to do your normal daily activitiesFree text: A couple days of vomiting in August along with about 2 weeks of dizziness and weakness.MedDRA releases: 2024-11 · check-in free text available
-
2021-10-26
Dose 3 — Moderna
-
2021-10-27
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: Good · Site: PainFree text: NoMedDRA releases: 2024-11 · check-in free text available
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: Good · Site: PainFree text: NoMedDRA releases: 2024-11 · check-in free text available
-
2021-10-29
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-09
- 2021-11-20
- 2021-11-24
- 2021-11-30
-
2021-12-07
Survey response — day 42, dose 3MedDRA: Blood pressure increased, Cough, Respiratory tract congestion — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Higher blood pressure readings. congestion, coughMedDRA releases: 2024-11 · check-in free text available
-
2021-12-07
Report sent to call center — day 42, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-12-08
-
2021-12-08
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-01-27
- 2022-04-28
-
2022-06-07
Dose 4 — Moderna
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2022-06-07
Survey response — day 0, dose 4MedDRA: Dizziness — Feeling: Good · Site: PainFree text: LightheadedMedDRA releases: 2024-11 · check-in free text available
-
2022-06-08
Survey response — days 1–6 daily, dose 4MedDRA: Brain fog — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: General brain fogMedDRA releases: 2024-11 · check-in free text available
- 2022-06-09
- 2022-06-10
- 2022-06-11
- 2022-06-12
- 2022-06-13
- 2022-06-14
- 2022-06-23
- 2022-06-28
- 2022-07-05
- 2022-07-12
- 2022-07-19
- 2022-09-06
-
2022-11-02
Dose 5 — Pfizer-BioNTechCo-administered: Flu
- 2022-11-02
-
2022-11-03
Survey response — days 1–6 daily, dose 5MedDRA: Respiratory tract congestion — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesFree text: CongestionMedDRA releases: 2024-11 · check-in free text available
-
2022-11-04
Survey response — days 1–6 daily, dose 5MedDRA: Respiratory tract congestion — Feeling: GoodFree text: CongestionMedDRA releases: 2024-11 · check-in free text available
- 2022-11-05
- 2022-11-07
- 2022-11-08
-
2022-11-09
Survey response — day 7, dose 5MedDRA: Respiratory tract congestion, Throat irritation — Feeling: Good · HeadacheFree text: Scratchy throat and congestionMedDRA releases: 2024-11 · check-in free text available
- 2022-11-16
- 2022-11-23
- 2022-11-30
- 2022-12-07
- 2022-12-14
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2023-02-01
Survey response — 3 months, dose 5MedDRA: Cough, Respiratory tract congestion, SARS-CoV-2 test positive, Unevaluable event — 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 visitMedDRA releases: 2024-11
-
2023-02-01
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)
-
2023-02-02
Call successfulDoes not wish to fill out VAERS report
- 2023-05-03
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-13 | Moderna | |
| 2 | 2021-04-13 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-06-07 | Moderna | No |
| 5 | 2022-11-02 | Pfizer-BioNTech | Flu |
Call center
2 call center cases
2 successful
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): I didnt start vsafe until a few days after my injection. Just wanted to get it on record the only symptom Ive had was slight pain at injection site on the day after. But nothing since.
Release 8 — day 14, dose 2
Symptoms: Constipation, lethargy.
Release 10 — 6 months, dose 2
Symptoms: A couple days of vomiting in August along with about 2 weeks of dizziness and weakness.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): No
Systemic reaction (other): No
Systemic reaction (other): No
Release 10 — day 42, dose 3
Symptoms: Higher blood pressure readings. congestion, cough
Release 11 — day 0, dose 4
Systemic reaction (other): Lightheaded
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): General brain fog
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Congestion
Systemic reaction (other): Congestion
Release 12 — day 7, dose 5
Systemic reaction (other): Scratchy throat and congestion
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 | Asthenia | · | · | ✓ |
| SD | Blood pressure increased | · | · | ✓ |
| SD | Constipation | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Lethargy | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
| SRO | Brain fog | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Respiratory tract congestion | · | · | ✓ |
| SRO | Throat irritation | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release