4QS-12820-86328
5 vaccinations
15 coded responses
52 check-ins
14 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 217 / MD
- Registered
- 2021-03-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-17
Dose 1 — Moderna
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2021-03-02
Registered in v-safe
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2021-03-03
Survey response — day 14, dose 1MedDRA: Injection site discolouration — Feeling: GoodFree text: Have a big pink circular spot on my left arm, about the size of a navel orange. I noticed it yesterday. It is near the injection spot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-17
Dose 2 — Moderna
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2021-03-17
Health check-in — day 0, dose 2Feeling: Fair · Site: Pain · Headache · Be unable to do your normal daily activitiesAdult check-in
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2021-03-18
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, Diarrhea, Abdominal painAdult check-in
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2021-03-19
Survey response — days 1–6 daily, dose 2MedDRA: Feeling abnormal, Nasal congestion, Nasopharyngitis — Feeling: Good · Site: Pain, Redness, Itching · FeverFree text: At bedtime last night, I felt as if I was getting a bad cold. I just felt bad and both nasal passages where badly blocked. This morning, that had gone away.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-20
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-03-24
- 2021-03-31
- 2021-04-07
- 2021-04-14
- 2021-04-21
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2021-04-28
Survey response — day 42, dose 2MedDRA: Arthralgia — Feeling: GoodFree text: Had bad shoulder pains for 3-4 daysMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-16
- 2021-09-15
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2021-10-22
Dose 3 — Moderna
- 2021-10-28
- 2021-10-29
- 2021-11-05
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2021-11-12
Survey response — day 21, dose 3MedDRA: Back pain, Headache — Feeling: GoodFree text: Had a mild headache for about 4 days and also had lower back pain.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-19
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2021-11-26
Survey response — day 35, dose 3MedDRA: Myalgia — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Muscles in both shoulders have been aching.MedDRA releases: 2024-11 · check-in free text available
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2021-12-03
Survey response — day 42, dose 3MedDRA: Headache, Nasal congestion, Oral candidiasis — Feeling: FairFree text: Have had thrush in my mouth. Had a really stuffy nose this morning, with a mild headache.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-21
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2022-04-05
Dose 4 — Moderna
- 2022-04-05
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2022-04-06
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Redness · Fatigue or tirednessAdult check-in
- 2022-04-07
- 2022-04-08
- 2022-04-09
- 2022-04-11
- 2022-04-12
- 2022-04-19
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2022-04-26
Survey response — day 21, dose 4MedDRA: Arthralgia, Candida infection, Neck pain, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Symptoms: Left shoulder and neck have been extremely painful for the past 6 days. I received the 2nd booster in my left arm. Also I have developed an extreme case of thrush. I had thrush 3 times last year. I never connected the cases of thrush and the vaccine. · Healthcare visit (other): Seeing my orthopedic doctor 4/27/22MedDRA releases: 2024-11 · check-in free text available
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2022-04-26
Report sent to call center — day 21, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-04-28
Call successfulParticipant prefers to complete VAERS report online
- 2022-05-03
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2022-05-10
Survey response — day 35, dose 4MedDRA: Arthralgia — Feeling: FairFree text: Left shoulder sore again.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-17
- 2022-07-05
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2022-09-22
Dose 5 — Moderna
- 2022-09-22
-
2022-09-23
Survey response — days 1–6 daily, dose 5MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain, RednessFree text: Runny noseMedDRA releases: 2024-11 · check-in free text available
- 2022-09-24
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2022-09-25
Survey response — days 1–6 daily, dose 5MedDRA: Rhinorrhoea — Feeling: Good · Site: Pain, RednessFree text: Runny noseMedDRA releases: 2024-11 · check-in free text available
- 2022-09-26
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2022-09-27
Survey response — days 1–6 daily, dose 5MedDRA: Rhinorrhoea — Feeling: GoodFree text: Runny noseMedDRA releases: 2024-11 · check-in free text available
- 2022-09-28
- 2022-10-01
- 2022-10-08
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2022-10-13
Survey response — day 21, dose 5MedDRA: Cough, Diarrhoea, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Sore throat, coughing, runny nose, congestion, diarrhea Got the flu shot 3 days agoMedDRA releases: 2024-11 · check-in free text available
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2022-10-20
Survey response — day 28, dose 5MedDRA: Chest pain, Cough, Musculoskeletal chest pain, Oropharyngeal pain — Feeling: Poor · 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: Caught got worse with sore throat and chest pain in my ribs from the cough.MedDRA releases: 2024-11 · check-in free text available
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2022-10-20
Report sent to call center — day 28, dose 5Be 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)
- 2022-10-21
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2022-10-21
Call successfulDoes not wish to fill out VAERS report
- 2022-10-29
- 2022-11-03
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2022-12-22
Survey response — 3 months, dose 5MedDRA: COVID-19, Candida infection, Cough, Dysphonia, Headache, Rhinorrhoea, SARS-CoV-2 test positive, Tetanus — 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: Headache, coughing, runny nose, raspy voice, thrush, tetanus. Actually got Covid. Tested positive Dec. 6, still testing positive today, Dec. 22.MedDRA releases: 2024-11 · check-in free text available
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2022-12-22
Report sent to call center — 3 months, dose 5Be 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)
- 2022-12-23
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2023-03-23
Survey response — 6 months, dose 5MedDRA: Blood urine present, Cystitis, Escherichia infection, Haemorrhage urinary tract, Hospitalisation, Lower respiratory tract infection, Office visit, Urinary tract infection — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11
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2023-03-23
Report sent to call center — 6 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2023-03-24
- 2023-03-24
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-17 | Moderna | |
| 2 | 2021-03-17 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-04-05 | Moderna | No |
| 5 | 2022-09-22 | Moderna | No |
Call center
4 call center cases
2 successful · 2 unsuccessful
Free text
Release 5 — day 14, dose 1
Symptoms: Have a big pink circular spot on my left arm, about the size of a navel orange. I noticed it yesterday. It is near the injection spot.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): At bedtime last night, I felt as if I was getting a bad cold. I just felt bad and both nasal passages where badly blocked. This morning, that had gone away.
Release 8 — day 42, dose 2
Symptoms: Had bad shoulder pains for 3-4 days
Release 10 — day 21, dose 3
Symptoms: Had a mild headache for about 4 days and also had lower back pain.
Release 10 — day 35, dose 3
Symptoms: Muscles in both shoulders have been aching.
Release 10 — day 42, dose 3
Symptoms: Have had thrush in my mouth. Had a really stuffy nose this morning, with a mild headache.
Release 11 — day 21, dose 4
Symptoms: Left shoulder and neck have been extremely painful for the past 6 days. I received the 2nd booster in my left arm. Also I have developed an extreme case of thrush. I had thrush 3 times last year. I never connected the cases of thrush and the vaccine. cut off by CDC
Healthcare visit (other): Seeing my orthopedic doctor 4/27/22
Release 11 — day 35, dose 4
Symptoms: Left shoulder sore again.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Runny nose
Systemic reaction (other): Runny nose
Systemic reaction (other): Runny nose
Release 12 — day 21, dose 5
Symptoms: Sore throat, coughing, runny nose, congestion, diarrhea Got the flu shot 3 days ago
Release 12 — day 28, dose 5
Symptoms: Caught got worse with sore throat and chest pain in my ribs from the cough.
Release 12 — 3 months, dose 5
Symptoms: Headache, coughing, runny nose, raspy voice, thrush, tetanus. Actually got Covid. Tested positive Dec. 6, still testing positive today, Dec. 22.
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 | Arthralgia | ✓ | ✓ | ✓ |
| SD | Back pain | · | · | ✓ |
| SD | Blood urine present | · | · | ✓ |
| SD | Candida infection | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Cystitis | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Dysphonia | · | · | ✓ |
| SD | Escherichia infection | · | · | ✓ |
| SD | Haemorrhage urinary tract | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Injection site discolouration | ✓ | ✓ | ✓ |
| SD | Lower respiratory tract infection | · | · | ✓ |
| SD | Musculoskeletal chest pain | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Neck pain | · | · | ✓ |
| SD | Oral candidiasis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Tetanus | · | · | ✓ |
| SD | Urinary tract infection | · | · | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | Nasal congestion | ✓ | ✓ | ✓ |
| SRO | Nasopharyngitis | ✓ | ✓ | ✓ |
| SRO | Rhinorrhoea | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release