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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

  1. 2021-02-11
    Dose 1 — Moderna
  2. 2021-02-13
    Registered in v-safe
  3. 2021-02-13
    Survey response — days 1–6 daily, dose 1
    MedDRA: Nightmare — Feeling: Good · Fatigue or tiredness
    Free text: Nightmare during daytime nap
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-18
    Survey response — day 7, dose 1
    MedDRA: Photopsia, Vitreous floaters — Feeling: Fair · Be unable to do your normal daily activities
    Free text: New large, round floater in vision of left eye along with occasional flashes
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-08
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  6. 2021-03-10
    Dose 2 — Moderna
  7. 2021-03-11
    Survey response — days 1–6 daily, dose 2
    MedDRA: Ear pain — Feeling: Fair · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Earache last night.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-03-13
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain, Itching · Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  9. 2021-03-16
    Survey response — days 1–6 daily, dose 2
    MedDRA: Tinnitus — Feeling: Good · Fatigue or tiredness
    Free text: Tinnitus
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-03-23
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  11. 2021-03-27
    Survey response — day 14, dose 2
    MedDRA: Dysgeusia, Immediate post-injection reaction — Feeling: Good
    Free 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
  12. 2021-09-14
    Survey response — 6 months, dose 2
    MedDRA: 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 visit
    Free text: Severe bronchitis
    MedDRA releases: 2024-11 · check-in free text available
  13. 2021-09-14
    Report sent to call center — 6 months, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  14. 2021-09-17
  15. 2022-03-10
    Survey response — 12 months, dose 2
    MedDRA: 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 consultation
    Free 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
  16. 2022-03-10
    Report sent to call center — 12 months, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    Telehealth, virtual health, or email health consultation · 1 call case(s)
  17. 2022-03-11
  18. 2022-03-11
    Call successful
    Participant prefers to complete VAERS report online

Vaccinations

DoseDateManufacturerCo-administered
12021-02-11Moderna
22021-03-10Moderna

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-13

Systemic reaction (other): Nightmare during daytime nap

Release 4 — day 7, dose 1

2021-02-18

Systemic reaction (other): New large, round floater in vision of left eye along with occasional flashes

Release 5 — days 1–6 daily, dose 2

2021-03-11

Systemic reaction (other): Earache last night.

2021-03-16

Systemic reaction (other): Tinnitus

Release 6 — day 14, dose 2

2021-03-27

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

2021-09-14

Symptoms: Severe bronchitis

Release 11 — 12 months, dose 2

2022-03-10

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

FieldPreferred term2021-092023-042024-11
SDAsthma · · ✓
SDBronchitis · · ✓
SDDysgeusia ✓ ✓ ✓
SDHypersensitivity · · ✓
SDImmediate post-injection reaction ✓ ✓ ✓
SDPre-existing disease · · ✓
SROEar pain ✓ ✓ ✓
SRONightmare ✓ ✓ ✓
SROPhotopsia ✓ ✓ ✓
SROTinnitus ✓ ✓ ✓
SROVitreous floaters ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release