525-27493-21695
3 vaccinations
4 coded responses
28 check-ins
4 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 907 / CA
- Registered
- 2021-04-03
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-03
Registered in v-safe
-
2021-04-03
Dose 1 — Moderna
- 2021-04-03
- 2021-04-04
-
2021-04-05
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Good · HeadacheFree text: Not sure if it is from Vaccination or sinuses. VERY MILD......NAGGING HEADACHEMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-06
- 2021-04-07
- 2021-04-08
- 2021-04-09
- 2021-04-10
- 2021-04-17
- 2021-04-24
-
2021-05-01
Dose 2 — Moderna
- 2021-05-01
- 2021-05-02
- 2021-05-03
- 2021-05-04
- 2021-05-05
- 2021-05-06
- 2021-05-07
- 2021-05-08
- 2021-05-15
- 2021-05-22
- 2021-05-29
- 2021-06-05
-
2021-06-12
Survey response — day 42, dose 2MedDRA: Fatigue — Feeling: FairFree text: Had fatigue for padt 2 week but didn't report it.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-07-31
- 2021-10-30
-
2021-12-20
Dose 3 — Moderna
-
2022-05-01
Survey response — 12 months, dose 2MedDRA: Groin pain, Immobile, Medical counselling, Office visit — 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 consultation, Outpatient clinic or urgent care clinic visitFree text: Symptoms: Unusual pain in groin area. Neurologist is trying to diagnose but cannot conclude why or what is cause of pain. This unusual pain causes immobility. · Healthcare visit (other): Phone and Office VisitsMedDRA releases: 2024-11 · check-in free text available
-
2022-05-01
Report sent to call center — 12 months, dose 2Be 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)
-
2022-05-03
Call successfulNot applicable - Accidental Reporting
- 2022-06-22
-
2022-12-20
Survey response — 12 months, dose 3MedDRA: Adverse reaction, Condition aggravated, Pain, Pre-existing disease, Unevaluable event — 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 · Telehealth, virtual health, or email health consultation, Emergency room or emergency department visit, HospitalizationFree text: Symptoms: Not sure if related but had disease for 20 years with no issues. Got vaccinated and I have experienced ALL side effects, expected exacerbations, pains, etc. · Healthcare visit (other): Need 24 hour assistanceMedDRA releases: 2024-11 · check-in free text available
-
2022-12-20
Report sent to call center — 12 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2022-12-21
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-03 | Moderna | |
| 2 | 2021-05-01 | Moderna | |
| 3 | 2021-12-20 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): Not sure if it is from Vaccination or sinuses. VERY MILD......NAGGING HEADACHE
Release 9 — day 42, dose 2
Symptoms: Had fatigue for padt 2 week but didn't report it.
Release 11 — 12 months, dose 2
Symptoms: Unusual pain in groin area. Neurologist is trying to diagnose but cannot conclude why or what is cause of pain. This unusual pain causes immobility.
Healthcare visit (other): Phone and Office Visits
Release 12 — 12 months, dose 3
Symptoms: Not sure if related but had disease for 20 years with no issues. Got vaccinated and I have experienced ALL side effects, expected exacerbations, pains, etc.
Healthcare visit (other): Need 24 hour assistance
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 | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Adverse reaction | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Groin pain | · | · | ✓ |
| SD | Immobile | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release