4FY-11790-70786
3 vaccinations
18 coded responses
24 check-ins
18 free-text entries
9 call cases
- Sex
- Female
- Age at first dose
- 21-25
- ZIP prefix
- 245 / VA
- Registered
- 2021-02-05
- Relationship
- Self
- Race
- White
- Ethnicity
- N/A
Timeline
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2021-02-05
Registered in v-safe
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2021-02-05
Dose 1 — Moderna
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2021-02-05
Survey response — day 0, dose 1MedDRA: Pre-existing disease — Feeling: Fair · Site: PainFree text: I have MCASMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-06
Survey response — days 1–6 daily, dose 1MedDRA: Pre-existing disease — Feeling: Fair · Site: PainFree text: MCASMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-07
Survey response — days 1–6 daily, dose 1MedDRA: Mast cell activation syndrome — Feeling: FairFree text: MCASMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-08
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: FairFree text: MCASMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-09
Survey response — days 1–6 daily, dose 1MedDRA: Mast cell activation syndrome — Feeling: FairFree text: MCASMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-11
Survey response — days 1–6 daily, dose 1MedDRA: Pre-existing disease — Feeling: FairFree text: MCASMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-12
Survey response — day 7, dose 1MedDRA: Mast cell activation syndrome — Feeling: FairFree text: MCASMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-19
Survey response — day 14, dose 1MedDRA: Gastrointestinal disorder — 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, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationFree text: Is unrelated GI issue that has been occurring since December 30th. May delay second dose administration.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-19
Report sent to call center — day 14, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-02-26
Survey response — day 21, dose 1MedDRA: Impaired gastric emptying — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationFree text: Diagnosed with gastroparesis- onset was pre vaccine so unrelatedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-26
Report sent to call center — day 21, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-05
- 2021-03-12
- 2021-03-21
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2021-04-16
Dose 2 — Moderna
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2021-04-22
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Fair · Nausea, Abdominal pain, Rash, not including the immediate area around the injection siteFree text: Related to other conditionsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-23
Health check-in — day 7, dose 2Feeling: Fair · Fatigue or tiredness, Nausea, Abdominal painAdult check-in
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2021-04-30
Survey response — day 14, dose 2MedDRA: Allergy to plants, Dental restoration failure, Hypersensitivity, Toothache, Unevaluable event — Feeling: PoorFree text: Allergic reaction to neighbor's weedFillings fell out so teeth hurtMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-07
Survey response — day 21, dose 2MedDRA: Mental disorder — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Mental health crisisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-07
Report sent to call center — day 21, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-05-14
Survey response — day 28, dose 2MedDRA: Depression, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visitFree text: Symptoms: Depression · Healthcare visit (other): Crisis intervention servicesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-14
Report sent to call center — day 28, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-05-21
Survey response — day 35, dose 2MedDRA: Depression — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Depression/ptsd from traumaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-21
Report sent to call center — day 35, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-05-28
Survey response — day 42, dose 2MedDRA: Pre-existing disease — Feeling: Poor · Get care from a doctor or other healthcare professional · HospitalizationFree text: Ptsd/depression (unrelated to vaccine)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-28
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-07-16
Survey response — 3 months, dose 2MedDRA: Respiratory fume inhalation disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Got smoke inhalation from a fireMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-07-16
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-07-23
- 2021-10-15
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2021-12-03
Dose 3 — Moderna
- 2022-04-16
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2022-06-03
Survey response — 6 months, dose 3MedDRA: Asthma, Burns first degree, Burns second degree, Burns third degree, Condition aggravated, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, 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, HospitalizationFree text: Asthma attack/ PTSD episode, 1st,2nd,3rd degree burnsMedDRA releases: 2024-11 · check-in free text available
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2022-06-03
Report sent to call center — 6 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
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2022-06-06
Call successfulDoes not wish to fill out VAERS report
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2022-06-06
Call successfulDoes not wish to fill out VAERS report
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2022-06-06
Call successfulReported to VAERS voluntarily prior to GDIT contact
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2022-06-06
Call successfulReported to VAERS voluntarily prior to GDIT contact
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2022-06-06
Call successfulReported to VAERS voluntarily prior to GDIT contact
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2022-06-06
Call successfulReported to VAERS voluntarily prior to GDIT contact
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2022-06-06
Call successfulReported to VAERS voluntarily prior to GDIT contact
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2022-06-06
Call successfulDoes not wish to fill out VAERS report
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2022-12-03
Survey response — 12 months, dose 3MedDRA: Mesenteric lymphadenitis, Osteopenia, Pre-existing disease — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Osteopenia (medication related), mesenteric adenitisMedDRA releases: 2024-11 · check-in free text available
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2022-12-03
Report sent to call center — 12 months, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
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2022-12-05
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 | 2021-02-05 | Moderna | |
| 2 | 2021-04-16 | Moderna | |
| 3 | 2021-12-03 | Moderna | No |
Call center
9 call center cases
9 successful
VAERS report filed, before or during a call: 5
Free text
Release 3 — day 0, dose 1
Systemic reaction (other): I have MCAS
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): MCAS
Systemic reaction (other): MCAS
Systemic reaction (other): MCAS
Systemic reaction (other): MCAS
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): MCAS
Release 4 — day 7, dose 1
Systemic reaction (other): MCAS
Release 4 — day 14, dose 1
Symptoms: Is unrelated GI issue that has been occurring since December 30th. May delay second dose administration.
Release 4 — day 21, dose 1
Symptoms: Diagnosed with gastroparesis- onset was pre vaccine so unrelated
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Related to other conditions
Release 8 — day 14, dose 2
Symptoms: Allergic reaction to neighbor's weedFillings fell out so teeth hurt
Release 8 — day 21, dose 2
Symptoms: Mental health crisis
Release 8 — day 28, dose 2
Release 8 — day 35, dose 2
Symptoms: Depression/ptsd from trauma
Release 8 — day 42, dose 2
Symptoms: Ptsd/depression (unrelated to vaccine)
Release 9 — 3 months, dose 2
Symptoms: Got smoke inhalation from a fire
Release 11 — 6 months, dose 3
Symptoms: Asthma attack/ PTSD episode, 1st,2nd,3rd degree burns
Release 12 — 12 months, dose 3
Symptoms: Osteopenia (medication related), mesenteric adenitis
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 | Office visit | ✓ | ✓ | ✓ |
| SD | Allergy to plants | ✓ | · | ✓ |
| SD | Asthma | · | · | ✓ |
| SD | Burns first degree | · | · | ✓ |
| SD | Burns second degree | · | · | ✓ |
| SD | Burns third degree | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Dental restoration failure | ✓ | · | ✓ |
| SD | Depression | ✓ | ✓ | ✓ |
| SD | Gastrointestinal disorder | ✓ | ✓ | ✓ |
| SD | Hypersensitivity | ✓ | ✓ | ✓ |
| SD | Impaired gastric emptying | ✓ | ✓ | ✓ |
| SD | Mental disorder | ✓ | ✓ | ✓ |
| SD | Mesenteric lymphadenitis | · | · | ✓ |
| SD | Osteopenia | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Respiratory fume inhalation disorder | ✓ | · | ✓ |
| SD | Toothache | ✓ | · | ✓ |
| SD | Unevaluable event | ○ | ✓ | ○ |
| SRO | Mast cell activation syndrome | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release