4JS-69692-02672
3 vaccinations
5 coded responses
38 check-ins
5 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 960 / CA
- Registered
- 2021-03-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-15
Dose 1 — Moderna
-
2021-03-16
Registered in v-safe
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-22
- 2021-03-29
- 2021-04-05
-
2021-04-12
Dose 2 — Moderna
- 2021-04-12
-
2021-04-13
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Fatigue or tirednessAdult check-in
-
2021-04-14
Survey response — days 1–6 daily, dose 2MedDRA: Diarrhoea, Flatulence — Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessFree text: Gas/loose stool x approx 12 hrs -now resolvedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-15
Survey response — days 1–6 daily, dose 2MedDRA: Flatulence — Feeling: Fair · Headache, Fatigue or tirednessFree text: Excessive gas started again today but no loose stools as beforeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-16
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-04-17
- 2021-04-18
-
2021-04-19
Survey response — day 7, dose 2MedDRA: Pre-existing disease, Vertigo — Feeling: GoodFree text: Ive had problems w/my vertigo the past few days. It had been much better so not sure if its related but feels like the vaccine may have triggered it again so just wanted to mention.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-26
- 2021-05-03
- 2021-05-10
- 2021-05-17
- 2021-05-24
- 2021-07-12
- 2021-10-11
-
2021-10-28
Dose 3 — Moderna
-
2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-10-30
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-11
- 2021-11-18
- 2021-11-25
- 2021-12-02
-
2022-01-28
Survey response — 3 months, dose 3MedDRA: Pre-existing disease, Tinnitus — Feeling: GoodFree text: I have almost constant tinnitus & has become more severe. I was treated for this many years ago but it resolved. This has returned since I had vaccine & increased since my booster. Didn't think about possible relationship to vaccine until recently.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-28
Survey response — 6 months, dose 3MedDRA: Chest pain, Dyspnoea exertional, Office visit, Presyncope — Feeling: Fair · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Symptoms: Chest pain, SOB and pre-syncope w/exertion. · Healthcare visit (other): Complete work up for heart, lungs, incl scans w/contrast for any possible clots, etc, & MRI of brain-results all negativeMedDRA releases: 2024-11 · check-in free text available
-
2022-04-28
Report sent to call center — 6 months, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-04-29
-
2022-04-29
Call successfulCompleted over the phone
- 2022-10-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-15 | Moderna | |
| 2 | 2021-04-12 | Moderna | |
| 3 | 2021-10-28 | Moderna | No |
Call center
1 call center case
1 successful
VAERS report filed, before or during a call: 1
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Gas/loose stool x approx 12 hrs -now resolved
Systemic reaction (other): Excessive gas started again today but no loose stools as before
Release 7 — day 7, dose 2
Systemic reaction (other): Ive had problems w/my vertigo the past few days. It had been much better so not sure if its related but feels like the vaccine may have triggered it again so just wanted to mention.
Release 11 — 3 months, dose 3
Symptoms: I have almost constant tinnitus & has become more severe. I was treated for this many years ago but it resolved. This has returned since I had vaccine & increased since my booster. Didn't think about possible relationship to vaccine until recently. cut off by CDC
Release 11 — 6 months, dose 3
Symptoms: Chest pain, SOB and pre-syncope w/exertion.
Healthcare visit (other): Complete work up for heart, lungs, incl scans w/contrast for any possible clots, etc, & MRI of brain-results all negative
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 | Chest pain | · | · | ✓ |
| SD | Dyspnoea exertional | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Presyncope | · | · | ✓ |
| SD | Tinnitus | · | · | ✓ |
| SRO | Diarrhoea | ✓ | ✓ | ✓ |
| SRO | Flatulence | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Vertigo | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release