4NJ-10011-12058
4 vaccinations
3 coded responses
44 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 26-30
- ZIP prefix
- 061 / CT
- Registered
- 2021-01-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-12
Dose 1 — Moderna
-
2021-01-13
Registered in v-safe
- 2021-01-13
-
2021-01-14
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-26
- 2021-02-02
-
2021-02-09
Dose 2 — Moderna
- 2021-02-09
-
2021-02-10
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to workAdult check-in
-
2021-02-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-05-11
- 2021-08-10
-
2021-10-24
Dose 3 — Moderna
-
2021-10-26
Survey response — days 1–6 daily, dose 3MedDRA: Cough, Headache, Paranasal sinus discomfort, Respiratory tract congestion — Feeling: Poor · Fever · Headache, Muscle or body aches, Fatigue or tiredness · 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 visitFree text: Sinus pressure, cough, congestion, headacheMedDRA releases: 2024-11 · check-in free text available
-
2021-10-26
Report sent to call center — days 1–6 daily, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-10-27
Survey response — days 1–6 daily, dose 3MedDRA: Cough, Paranasal sinus discomfort, Sneezing — Feeling: Poor · Headache · Be unable to work or attend schoolFree text: Sinus pressure, coughing, sneezingMedDRA releases: 2024-11 · check-in free text available
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Cough, Respiratory tract congestion, Rhinorrhoea — Feeling: Fair · Headache · Be unable to do your normal daily activitiesFree text: Coughing, congestion, runny noseMedDRA releases: 2024-11 · check-in free text available
-
2021-10-28
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-10-29
- 2021-10-30
- 2021-11-02
- 2021-11-07
- 2021-11-14
- 2021-11-21
- 2021-11-28
- 2021-12-05
- 2022-01-23
- 2022-04-24
-
2022-09-24
Dose 4 — ModernaCo-administered: Flu
- 2022-09-29
- 2022-10-01
- 2022-10-08
- 2022-10-17
- 2022-10-24
- 2022-10-31
- 2023-03-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-12 | Moderna | |
| 2 | 2021-02-09 | Moderna | |
| 3 | 2021-10-24 | Moderna | No |
| 4 | 2022-09-24 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-10-26 | Successful 2021-10-28 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Sinus pressure, cough, congestion, headache
Systemic reaction (other): Sinus pressure, coughing, sneezing
Systemic reaction (other): Coughing, congestion, runny nose
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 |
|---|---|---|---|---|
| SRO | Cough | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Paranasal sinus discomfort | · | · | ✓ |
| SRO | Respiratory tract congestion | · | · | ✓ |
| SRO | Rhinorrhoea | · | · | ✓ |
| SRO | Sneezing | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release