4PS-20457-80479
5 vaccinations
6 coded responses
47 check-ins
5 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 980 / WA
- Registered
- 2021-01-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-19
Registered in v-safe
-
2021-01-19
Dose 1 — Moderna
-
2021-01-19
Survey response — day 0, dose 1MedDRA: Feeling jittery — Feeling: Good · Fatigue or tirednessFree text: Slightly jittery in my legs.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-22
- 2021-01-23
-
2021-01-24
Survey response — days 1–6 daily, dose 1MedDRA: Hyperhidrosis — Feeling: Fair · Site: Pain · Fever · Fatigue or tirednessFree text: Sweats upon waking this morning.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-25
- 2021-01-26
- 2021-02-02
- 2021-02-09
-
2021-02-16
Dose 2 — Moderna
- 2021-02-16
-
2021-02-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
-
2021-05-18
Survey response — 3 months, dose 2MedDRA: Chills, Emergency care, Headache, Pyrexia, Somnolence, Tremor — Feeling: Good · 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 visitFree text: Chills and uncontrollable shaking followed by intermittent low fever, drowsiness, and headache for 5 or 6 days. Went to an emergency clinic where several tests were conducted with no conclusion (plus neg. COVID test). Conditi went away on its own.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-18
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-17
-
2021-10-17
Dose 3 — Moderna
- 2021-10-24
- 2021-10-31
- 2021-11-07
- 2021-11-14
- 2021-11-22
- 2021-11-28
- 2022-01-16
- 2022-02-11
-
2022-04-11
Dose 4 — Moderna
- 2022-04-14
- 2022-04-15
- 2022-04-16
- 2022-04-17
- 2022-04-18
- 2022-04-25
-
2022-05-03
Survey response — day 21, dose 4MedDRA: Medical counselling, Nausea, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: I occasionally have mild nausea. I think it is due to chronic shoulder pain from rotator cuff injury and frozen shoulder. I have experienced this for several weeks. · Healthcare visit (other): Phone query and appointment scheduled with orthopedic surgeonMedDRA releases: 2024-11 · check-in free text available
-
2022-05-03
Report sent to call center — day 21, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-05-04
- 2022-05-09
- 2022-05-16
-
2022-05-23
Survey response — day 42, dose 4MedDRA: SARS-CoV-2 test positive — 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 consultationFree text: Tested positive for COVID-19MedDRA releases: 2024-11 · check-in free text available
-
2022-05-23
Report sent to call center — day 42, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-05-24
- 2022-05-24
- 2022-05-24
-
2022-05-24
Call successfulDoes not wish to fill out VAERS report
-
2022-05-24
Call successfulDoes not wish to fill out VAERS report
-
2022-05-24
Call successfulDoes not wish to fill out VAERS report
- 2022-07-11
-
2022-09-13
Dose 5 — Moderna
- 2022-09-30
- 2022-10-04
- 2022-10-11
- 2022-10-18
- 2022-12-13
-
2023-03-14
Survey response — 6 months, dose 5MedDRA: Fatigue, Headache, Pain, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-19 | Moderna | |
| 2 | 2021-02-16 | Moderna | |
| 3 | 2021-10-17 | Moderna | No |
| 4 | 2022-04-11 | Moderna | No |
| 5 | 2022-09-13 | Moderna | No |
Call center
3 call center cases
3 successful
1 wait over 3 months for a first call
Free text
Release 2 — day 0, dose 1
Systemic reaction (other): Slightly jittery in my legs.
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Sweats upon waking this morning.
Release 8 — 3 months, dose 2
Symptoms: Chills and uncontrollable shaking followed by intermittent low fever, drowsiness, and headache for 5 or 6 days. Went to an emergency clinic where several tests were conducted with no conclusion (plus neg. COVID test). Conditi went away on its own. cut off by CDC
Release 11 — day 21, dose 4
Symptoms: I occasionally have mild nausea. I think it is due to chronic shoulder pain from rotator cuff injury and frozen shoulder. I have experienced this for several weeks.
Healthcare visit (other): Phone query and appointment scheduled with orthopedic surgeon
Release 11 — day 42, dose 4
Symptoms: Tested positive for COVID-19
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 | Medical counselling | · | · | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Somnolence | ✓ | ✓ | ✓ |
| SD | Tremor | ✓ | ✓ | ✓ |
| SRO | Feeling jittery | ✓ | ✓ | ✓ |
| SRO | Hyperhidrosis | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release