3Z2-16854-09281
2 vaccinations
7 coded responses
10 check-ins
7 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 787 / TX
- Registered
- 2021-02-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-11
Dose 1 — Moderna
-
2021-02-13
Registered in v-safe
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2021-02-13
Survey response — days 1–6 daily, dose 1MedDRA: Nightmare — Feeling: Good · Fatigue or tirednessFree text: Nightmare during daytime napMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-18
Survey response — day 7, dose 1MedDRA: Photopsia, Vitreous floaters — Feeling: Fair · Be unable to do your normal daily activitiesFree text: New large, round floater in vision of left eye along with occasional flashesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-08
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2021-03-10
Dose 2 — Moderna
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2021-03-11
Survey response — days 1–6 daily, dose 2MedDRA: Ear pain — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Earache last night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-13
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-03-16
Survey response — days 1–6 daily, dose 2MedDRA: Tinnitus — Feeling: Good · Fatigue or tirednessFree text: TinnitusMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-23
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2021-03-27
Survey response — day 14, dose 2MedDRA: Dysgeusia, Immediate post-injection reaction — Feeling: GoodFree text: Continue to have ocassionally a metallic taste in my mouth which I first noticed right after getting the Moderna vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-09-14
Survey response — 6 months, dose 2MedDRA: Bronchitis — 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: Severe bronchitisMedDRA releases: 2024-11 · check-in free text available
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2021-09-14
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)
- 2021-09-17
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2022-03-10
Survey response — 12 months, dose 2MedDRA: Asthma, Hypersensitivity, Pre-existing disease — Feeling: Poor · 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: I have developed asthma in the past 3 months. I have never had asthma before although I have had allergies and alleegic rhinitis. I believe that the 3 Moderna vaccines have made my immune system hyper-sensitive to allergens resulting in new asthma.MedDRA releases: 2024-11 · check-in free text available
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2022-03-10
Report sent to call center — 12 months, dose 2Be 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)
- 2022-03-11
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2022-03-11
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-11 | Moderna | |
| 2 | 2021-03-10 | Moderna |
Call center
2 call center cases
2 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Nightmare during daytime nap
Release 4 — day 7, dose 1
Systemic reaction (other): New large, round floater in vision of left eye along with occasional flashes
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Earache last night.
Systemic reaction (other): Tinnitus
Release 6 — day 14, dose 2
Symptoms: Continue to have ocassionally a metallic taste in my mouth which I first noticed right after getting the Moderna vaccine.
Release 9 — 6 months, dose 2
Symptoms: Severe bronchitis
Release 11 — 12 months, dose 2
Symptoms: I have developed asthma in the past 3 months. I have never had asthma before although I have had allergies and alleegic rhinitis. I believe that the 3 Moderna vaccines have made my immune system hyper-sensitive to allergens resulting in new asthma. cut off by CDC
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 | Asthma | · | · | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Dysgeusia | ✓ | ✓ | ✓ |
| SD | Hypersensitivity | · | · | ✓ |
| SD | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Ear pain | ✓ | ✓ | ✓ |
| SRO | Nightmare | ✓ | ✓ | ✓ |
| SRO | Photopsia | ✓ | ✓ | ✓ |
| SRO | Tinnitus | ✓ | ✓ | ✓ |
| SRO | Vitreous floaters | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release