4JP-73678-18193
5 vaccinations
7 coded responses
67 check-ins
7 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 074 / NJ
- Registered
- 2021-01-14
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-14
Registered in v-safe
-
2021-01-14
Dose 1 — Moderna
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-21
- 2021-01-28
- 2021-02-04
-
2021-02-11
Dose 2 — Moderna
-
2021-02-11
Health check-in — day 0, dose 2Feeling: Good · Site: Pain, Swelling · Joint pains, Muscle or body achesAdult check-in
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2021-02-12
Survey response — days 1–6 daily, dose 2MedDRA: Body temperature increased, Pyrexia — Feeling: Good · Site: Pain, Swelling, Itching · Chills, Joint pains, Muscle or body achesFree text: These started 24 hours after the shot. Just after filing yesterdays report. Also ran a fever of 100.6. Symptoms abated after 6 hours.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-13
-
2021-02-14
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Swelling, Itching · NoneAdult check-in
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-03-11
- 2021-03-18
- 2021-03-25
-
2021-05-13
Survey response — 3 months, dose 2MedDRA: Eczema, Pre-existing disease — Feeling: GoodFree text: Eczema on my fingers. Havent had that since my early 20s, which is over 50 years ago. Vesicles that itch and burn.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-08-12
Survey response — 6 months, dose 2MedDRA: Eczema, Pre-existing disease — Feeling: GoodFree text: Eczema on hands. Blisters that itch. Had eczema as a child. Last occurrence was in my mid twenties on my hands.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-10-26
Dose 3 — Moderna
- 2021-10-26
-
2021-10-27
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-09
- 2021-11-16
- 2021-11-23
- 2021-11-30
- 2021-12-07
- 2022-01-25
-
2022-04-20
Dose 4 — Moderna
- 2022-04-20
- 2022-04-21
-
2022-04-22
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection siteAdult check-in
-
2022-04-23
Health check-in — days 1–6 daily, dose 4Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2022-04-24
Health check-in — days 1–6 daily, dose 4Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2022-04-25
Health check-in — days 1–6 daily, dose 4Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2022-04-26
Health check-in — days 1–6 daily, dose 4Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2022-04-27
Survey response — day 7, dose 4MedDRA: Dyspnoea, Influenza virus test negative, Productive cough, SARS-CoV-2 test negative — Feeling: Fair · Fever · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Productive cough shortness of breath. Had a rapid pcr test for COVID, flu and RSV. All are negative.MedDRA releases: 2024-11 · check-in free text available
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2022-04-27
Report sent to call center — day 7, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-04-29
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-05-04
- 2022-05-11
- 2022-05-18
- 2022-05-25
- 2022-06-01
- 2022-07-20
-
2022-09-29
Dose 5 — Moderna
- 2022-09-29
- 2022-09-30
- 2022-10-01
- 2022-10-02
- 2022-10-03
- 2022-10-04
- 2022-10-05
- 2022-10-06
- 2022-10-13
-
2022-10-20
Survey response — day 21, dose 5MedDRA: Alopecia areata, Eczema, Pre-existing disease — Feeling: GoodFree text: After 2nd vaccination I developed eczema on my hands which I haven't had since my early 20's. Now I've developed alopecia in my beard which is also an autoimmune disorder. Don't know if it's related to the booster. Will ask dermatologist next monthMedDRA releases: 2024-11 · check-in free text available
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2022-10-27
Survey response — day 28, dose 5MedDRA: Lower respiratory tract infection, SARS-CoV-2 test negative — Feeling: FairFree text: Have a chest cold. Negative COVID testMedDRA releases: 2024-11 · check-in free text available
- 2022-11-03
- 2022-11-10
-
2022-12-29
Survey response — 3 months, dose 5MedDRA: Alopecia areata, COVID-19, Influenza — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Had flu and Covid. Also have alopecia barbae - vaccine??MedDRA releases: 2024-11 · check-in free text available
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2022-12-29
Report sent to call center — 3 months, dose 5Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-12-30
-
2022-12-30
Callback requested for07:15PM ET
-
2022-12-30
Call successfulCompleted over the phone
- 2023-03-30
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-14 | Moderna | |
| 2 | 2021-02-11 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-04-20 | Moderna | No |
| 5 | 2022-09-29 | Moderna | No |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 1
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): These started 24 hours after the shot. Just after filing yesterdays report. Also ran a fever of 100.6. Symptoms abated after 6 hours.
Release 8 — 3 months, dose 2
Symptoms: Eczema on my fingers. Havent had that since my early 20s, which is over 50 years ago. Vesicles that itch and burn.
Release 9 — 6 months, dose 2
Symptoms: Eczema on hands. Blisters that itch. Had eczema as a child. Last occurrence was in my mid twenties on my hands.
Release 11 — day 7, dose 4
Systemic reaction (other): Productive cough shortness of breath. Had a rapid pcr test for COVID, flu and RSV. All are negative.
Release 12 — day 21, dose 5
Symptoms: After 2nd vaccination I developed eczema on my hands which I haven't had since my early 20's. Now I've developed alopecia in my beard which is also an autoimmune disorder. Don't know if it's related to the booster. Will ask dermatologist next month cut off by CDC
Release 12 — day 28, dose 5
Symptoms: Have a chest cold. Negative COVID test
Release 12 — 3 months, dose 5
Symptoms: Had flu and Covid. Also have alopecia barbae - 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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| SD | Alopecia areata | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Eczema | ✓ | ✓ | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Lower respiratory tract infection | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Body temperature increased | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | · | · | ✓ |
| SRO | Influenza virus test negative | · | · | ✓ |
| SRO | Productive cough | · | · | ✓ |
| SRO | Pyrexia | ✓ | ✓ | ✓ |
| SRO | SARS-CoV-2 test negative | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release