4KA-26217-22745
4 vaccinations
10 coded responses
48 check-ins
9 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 112 / NY
- Registered
- 2021-01-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-18
Registered in v-safe
-
2021-01-18
Dose 1 — Moderna
- 2021-01-18
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2021-01-21
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Redness, Swelling · Fatigue or tirednessAdult check-in
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-02-01
-
2021-02-08
Survey response — day 21, dose 1MedDRA: Ear pain, Neck pain, Noninfective gingivitis, Tooth disorder, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: I have a tooth problem and am going to the dentist now. I have inflammation of my gums on my right side and painful neck and ear on rt. Side. Not sure if I have an infection. · Healthcare visit (other): Going to dentists officeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-08
Report sent to call center — day 21, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-15
-
2021-02-16
Dose 2 — Moderna
- 2021-02-22
- 2021-02-23
-
2021-03-02
Survey response — day 14, dose 2MedDRA: Abdominal pain upper, Impaired work ability — Feeling: Poor · Be unable to workFree text: I have a stomach ache now but it may have nothing to do with the vaccine. Im resting nowcant work til this stomach ache lessens. I did work earlier today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-11
- 2021-03-16
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2021-03-23
Survey response — day 35, dose 2MedDRA: Fatigue, Oropharyngeal pain — Feeling: FairFree text: It may not be related to the vaccine, but I have a sore throat and feel very tired.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-30
- 2021-05-18
-
2021-07-23
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-08-17
-
2021-10-26
Dose 3 — Moderna
- 2021-10-26
-
2021-10-27
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
-
2021-11-01
Survey response — days 1–6 daily, dose 3MedDRA: Arthralgia — Feeling: GoodFree text: Pain in left ankle jointMedDRA releases: 2024-11 · check-in free text available
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2021-11-02
Survey response — day 7, dose 3MedDRA: Arthralgia — Feeling: GoodFree text: Pain in left ankle joint which began shortly after received booster.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-09
- 2021-11-16
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2021-11-23
Survey response — day 28, dose 3MedDRA: Cardiovascular symptom, Chest pain, Electrocardiogram abnormal, Emergency care — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: I experienced strong chest pains and ended up in the ER, since the physician at (b)(6) thought I was having a heart attack upon doing an ekg and finding an abnormality. At the ER, another EKG was done and it was normal. Pain in chest was for 20min.MedDRA releases: 2024-11 · check-in free text available
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2021-11-23
Report sent to call center — day 28, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
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2021-11-24
Call successfulParticipant prefers to complete VAERS report online
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2021-11-30
Survey response — day 35, dose 3MedDRA: Chest pain, Emergency care, Office visit, SARS-CoV-2 test — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: I had chest pains while getting a covid test at city md. The pain lasted 20 minutes. They sent me to the ER in an ambulance, since the doctor thought I could be having a heart attack.MedDRA releases: 2024-11 · check-in free text available
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2021-11-30
Report sent to call center — day 35, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2021-12-01
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-12-07
- 2022-01-25
- 2022-04-26
-
2022-05-27
Dose 4 — Moderna
-
2022-05-28
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-05-29
-
2022-05-30
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-05-31
- 2022-06-01
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2022-06-02
Health check-in — days 1–6 daily, dose 4Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-06-05
- 2022-06-10
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2022-06-17
Survey response — day 21, dose 4MedDRA: Dyspnoea, Oxygen saturation decreased, Sleep study abnormal — Feeling: FairFree text: Not able to breathe as deeply. A home sleep study showed low o2 saturation 1/3 of the nite. Unsure if related to vaccine.MedDRA releases: 2024-11 · check-in free text available
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2022-06-24
Survey response — day 28, dose 4MedDRA: Dizziness — Feeling: Fair · Be unable to do your normal daily activitiesFree text: I've been feeling dizzy on and off for at least the past 2 weeks.MedDRA releases: 2024-11 · check-in free text available
- 2022-07-01
- 2022-07-08
- 2022-08-26
- 2022-11-27
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2023-05-27
Survey response — 12 months, dose 4MedDRA: Office visit, Sciatica — 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 · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
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2023-05-27
Call case (no matching report) — SuccessfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-05-30
-
2023-05-30
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 | 2021-01-18 | Moderna | |
| 2 | 2021-02-16 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-05-27 | Moderna | No |
Call center
4 call center cases
4 successful
Free text
Release 3 — day 21, dose 1
Symptoms: I have a tooth problem and am going to the dentist now. I have inflammation of my gums on my right side and painful neck and ear on rt. Side. Not sure if I have an infection.
Healthcare visit (other): Going to dentists office
Release 4 — day 14, dose 2
Symptoms: I have a stomach ache now but it may have nothing to do with the vaccine. Im resting nowcant work til this stomach ache lessens. I did work earlier today.
Release 6 — day 35, dose 2
Symptoms: It may not be related to the vaccine, but I have a sore throat and feel very tired.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Pain in left ankle joint
Release 10 — day 7, dose 3
Systemic reaction (other): Pain in left ankle joint which began shortly after received booster.
Release 10 — day 28, dose 3
Symptoms: I experienced strong chest pains and ended up in the ER, since the physician at (b)(6) thought I was having a heart attack upon doing an ekg and finding an abnormality. At the ER, another EKG was done and it was normal. Pain in chest was for 20min. cut off by CDC
redacted (b)(6)
Release 10 — day 35, dose 3
Symptoms: I had chest pains while getting a covid test at city md. The pain lasted 20 minutes. They sent me to the ER in an ambulance, since the doctor thought I could be having a heart attack.
Release 12 — day 21, dose 4
Symptoms: Not able to breathe as deeply. A home sleep study showed low o2 saturation 1/3 of the nite. Unsure if related to vaccine.
Release 12 — day 28, dose 4
Symptoms: I've been feeling dizzy on and off for at least the past 2 weeks.
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 | · | · | ✓ |
| HCVO | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Cardiovascular symptom | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Ear pain | ✓ | ✓ | ✓ |
| SD | Electrocardiogram abnormal | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Impaired work ability | ✓ | · | ✓ |
| SD | Neck pain | ✓ | ✓ | ✓ |
| SD | Noninfective gingivitis | ✓ | ✓ | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Oxygen saturation decreased | · | · | ✓ |
| SD | SARS-CoV-2 test | · | · | ✓ |
| SD | Sciatica | · | · | ✓ |
| SD | Sleep study abnormal | · | · | ✓ |
| SD | Tooth disorder | ✓ | ✓ | ✓ |
| SRO | Arthralgia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release