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4BS-21222-57956

3 vaccinations 4 coded responses 12 check-ins 4 free-text entries 4 call cases
Sex
Female
Age at first dose
61-65
ZIP prefix
442 / OH
Registered
2021-01-18
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-05
    Dose 1 — Moderna
  2. 2021-01-18
    Registered in v-safe
  3. 2021-01-18
    Survey response — day 7, dose 1
    MedDRA: Adverse reaction, Dyspnoea, Emergency care, Headache, Unevaluable event — Feeling: Fair · Site: Pain · Headache · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit
    Free text: Systemic reaction (other): Shortness of breath since 1/12/21. Bad headache 1/12/13 - 1/13/21. Went to ER for SOB 1/14/21. · Healthcare visit (other): Again, these symptoms were LAST WEEK, not today. The weeks of 1/11/21.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-01-18
    Report sent to call center — day 7, dose 1
    Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  5. 2021-01-19
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  6. 2021-01-28
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  7. 2021-02-05
    Dose 2 — Moderna
  8. 2021-02-09
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Fatigue or tiredness, Nausea, Abdominal pain
    Adult check-in
  9. 2021-02-10
    Survey response — days 1–6 daily, dose 2
    MedDRA: Dyspnoea — Feeling: Poor · Site: Redness, Swelling, Itching · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit
    Free text: VERY SHORT OF BREATH SINCE FIRST VACCINE!!
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-02-10
    Report sent to call center — days 1–6 daily, dose 2
    Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  11. 2021-02-11
    Survey response — days 1–6 daily, dose 2
    MedDRA: Dyspnoea, Fibrin D dimer increased — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit
    Free text: Systemic reaction (other): Short of breath since first shot Jan 5. Extremely high D-dimer (over 8000) since first shot. Today I had to have an ultrasound of my legs and CT of abdomen due to d-diimer · Healthcare visit (other): CT of abdomen and ultrasound of legs due to extremely high d-dimer level since first vaccine Jan 5
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-02-11
    Report sent to call center — days 1–6 daily, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  13. 2021-02-12
    Survey response — day 7, dose 2
    MedDRA: Dyspnoea — Feeling: Fair · Site: Pain, Redness, Swelling, Itching · Headache, Joint pains, Fatigue or tiredness
    Free text: SHORT OF BREATH SINCE FIRST VACCINE
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-02-19
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-03-22
  16. 2021-07-17
    Call successful
    Participant prefers to complete VAERS report online
  17. 2021-10-22
    Dose 3 — Moderna
  18. 2021-10-25
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Adult check-in
  19. 2021-10-25
    Report sent to call center — days 1–6 daily, dose 3
    Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  20. 2021-10-26
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Redness, Swelling, Itching · None
    Adult check-in
  21. 2021-10-27
    Health check-in — days 1–6 daily, dose 3
    Feeling: Fair · Site: Redness, Swelling, Itching · None
    Adult check-in
  22. 2021-10-28
  23. 2021-11-05
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-05Moderna
22021-02-05Moderna
32021-10-22Moderna No

Call center

4 call center cases

2 successful · 2 unsuccessful

See the call center timeline

Free text

Release 2 — day 7, dose 1

2021-01-18

Systemic reaction (other): Shortness of breath since 1/12/21. Bad headache 1/12/13 - 1/13/21. Went to ER for SOB 1/14/21.
Healthcare visit (other): Again, these symptoms were LAST WEEK, not today. The weeks of 1/11/21.

Release 4 — days 1–6 daily, dose 2

2021-02-10

Systemic reaction (other): VERY SHORT OF BREATH SINCE FIRST VACCINE!!

2021-02-11

Systemic reaction (other): Short of breath since first shot Jan 5. Extremely high D-dimer (over 8000) since first shot. Today I had to have an ultrasound of my legs and CT of abdomen due to d-diimer
Healthcare visit (other): CT of abdomen and ultrasound of legs due to extremely high d-dimer level since first vaccine Jan 5

Release 4 — day 7, dose 2

2021-02-12

Systemic reaction (other): SHORT OF BREATH SINCE FIRST VACCINE

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
HCVOAdverse reaction ✓ · ✓
HCVOEmergency care ○ ✓ ○
HCVOFibrin D dimer increased ✓ ✓ ✓
HCVOUnevaluable event ○ ✓ ○
SRODyspnoea ✓ ✓ ✓
SROEmergency care ✓ ✓ ✓
SROFibrin D dimer increased ✓ ✓ ✓
SROHeadache ✓ ✓ ✓

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