54C-15913-83190
5 vaccinations
13 coded responses
66 check-ins
10 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 56-60
- ZIP prefix
- 105 / NY
- Registered
- 2021-03-12
- Relationship
- Self
- Race
- N/A
- Ethnicity
- N/A
Timeline
-
2021-03-12
Registered in v-safe
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2021-03-12
Dose 1 — Moderna
- 2021-03-12
- 2021-03-13
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2021-03-14
Survey response — days 1–6 daily, dose 1MedDRA: Headache — Feeling: Good · HeadacheFree text: I dont think my headache was caused by the vaccine, but The answer to the question have I experienced a headache today is yes.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-02
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2021-04-09
Dose 2 — Moderna
- 2021-04-09
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2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Redness, Swelling · Headache, Fatigue or tirednessAdult check-in
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2021-04-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Swelling, Itching · NoneAdult check-in
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2021-04-12
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Swelling · Fatigue or tirednessAdult check-in
-
2021-04-14
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
-
2021-04-15
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-04-16
- 2021-04-23
- 2021-05-01
- 2021-05-07
- 2021-05-14
- 2021-05-22
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2021-07-11
Survey response — 3 months, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: Strange mark on my arm. Havent shown it to a dermatologist yet.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-10-08
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2021-11-18
Dose 3 — Moderna
- 2021-11-18
- 2021-11-19
- 2021-11-20
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2021-11-21
Survey response — days 1–6 daily, dose 3MedDRA: Fatigue, Headache, Insomnia — Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: I've had great difficulty sleeping during the past few nights. Not sure this has anything to do with the booster and it is probably the cause of my tiredness and headacheMedDRA releases: 2024-11 · check-in free text available
- 2021-11-22
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2021-11-23
Health check-in — days 1–6 daily, dose 3Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-24
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2021-11-25
Health check-in — day 7, dose 3Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-12-02
- 2021-12-10
- 2021-12-16
- 2022-01-03
- 2022-05-19
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2022-05-26
Dose 4 — Moderna
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2022-05-27
Survey response — days 1–6 daily, dose 4MedDRA: Insomnia, Malaise, Pre-existing disease, Tinnitus — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: I'm not really nauseous, but I don't feel great. Last night I had insomnia and then didn't sleep much. I don't know whether that had anything to do with the shot. My tinnitus seems to have gotten worse.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-28
- 2022-05-29
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2022-05-30
Survey response — days 1–6 daily, dose 4MedDRA: Malaise, Oropharyngeal pain, Rash, Self-medication — Feeling: Fair · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesFree text: I've had a small rash for a few days, but didn't think about it when reporting to v-safe until now. Last night, I felt like I was getting a sore throat. I took Echinecea & an Airborne tablet and it went away. Feeling somewhat unwell today.MedDRA releases: 2024-11 · check-in free text available
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2022-05-31
Health check-in — days 1–6 daily, dose 4Feeling: Good · Fatigue or tiredness, Rash, not including the immediate area around the injection siteAdult check-in
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2022-06-01
Survey response — days 1–6 daily, dose 4MedDRA: Herpes zoster, Office visit, Rash — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activitiesFree text: My doctor thinks my rash is Shingles. He swabbed it and I will get the test result in a week. I am now taking Valacyclovir HCL for shingles, which may affect how I feel during the next week.MedDRA releases: 2024-11 · check-in free text available
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2022-06-02
Survey response — day 7, dose 4MedDRA: Malaise, Medical counselling, Nasal congestion, Neck pain, Office visit, Pain in extremity, Rash — Feeling: Poor · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): Generally feel unwell, stuffy nose. Neck and arm ache on side where rash is. Symptoms may be from shingles or the anti- viral I am taking in case I have shingles. · Healthcare visit (other): Yesterday I saw my doctor in an in person visit to show him my rash and today I communicated with him about by symptoms in writing via a messaging system. Yesterday, I mistakenly did not mark the box saying I sought medical attention.MedDRA releases: 2024-11 · check-in free text available
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2022-06-02
Report sent to call center — day 7, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2022-06-03
Call successfulCompleted over the phone
- 2022-06-10
- 2022-06-16
- 2022-06-23
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2022-06-30
Survey response — day 35, dose 4MedDRA: Unevaluable event — Feeling: GoodFree text: I think I have a wart on my face. I have not gotten care from a healthcare professional yet, but I will probably have a dermatologist remove it.MedDRA releases: 2024-11 · check-in free text available
- 2022-07-07
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2022-08-27
Survey response — 3 months, dose 4MedDRA: Fungal skin infection, Urticaria — Feeling: GoodFree text: Fungal rash, developed a hive in reaction to a tetanus shot - though I've never had that reaction to a tetanus or other shot before.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-25
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2022-12-22
Dose 5 — Moderna
- 2022-12-22
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2022-12-23
Survey response — days 1–6 daily, dose 5MedDRA: Malaise — Feeling: Fair · HeadacheFree text: Not feeling greatMedDRA releases: 2024-11 · check-in free text available
- 2022-12-24
- 2022-12-25
- 2022-12-26
- 2022-12-27
- 2022-12-28
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2022-12-29
Health check-in — day 7, dose 5Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2023-01-05
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2023-01-12
Survey response — day 21, dose 5MedDRA: Hand fracture, Office visit — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
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2023-01-12
Report sent to call center — day 21, dose 5Be unable to work or attend school · Get care from a doctor or other healthcare professional1 call case(s)
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2023-01-13
Call successfulNot applicable - Accidental Reporting
- 2023-01-19
- 2023-01-26
- 2023-02-02
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2023-03-23
Survey response — 3 months, dose 5MedDRA: Accident, Hand fracture, Ligament sprain, Office visit, Physiotherapy — Feeling: Fair · 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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2023-03-23
Report sent to call center — 3 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2023-03-24
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-06-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-12 | Moderna | |
| 2 | 2021-04-09 | Moderna | |
| 3 | 2021-11-18 | Moderna | No |
| 4 | 2022-05-26 | Moderna | No |
| 5 | 2022-12-22 | Moderna | No |
Call center
3 call center cases
3 successful
VAERS report filed, before or during a call: 1
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): I dont think my headache was caused by the vaccine, but The answer to the question have I experienced a headache today is yes.
Release 9 — 3 months, dose 2
Symptoms: Strange mark on my arm. Havent shown it to a dermatologist yet.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): I've had great difficulty sleeping during the past few nights. Not sure this has anything to do with the booster and it is probably the cause of my tiredness and headache
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): I'm not really nauseous, but I don't feel great. Last night I had insomnia and then didn't sleep much. I don't know whether that had anything to do with the shot. My tinnitus seems to have gotten worse.
Systemic reaction (other): I've had a small rash for a few days, but didn't think about it when reporting to v-safe until now. Last night, I felt like I was getting a sore throat. I took Echinecea & an Airborne tablet and it went away. Feeling somewhat unwell today.
Systemic reaction (other): My doctor thinks my rash is Shingles. He swabbed it and I will get the test result in a week. I am now taking Valacyclovir HCL for shingles, which may affect how I feel during the next week.
Release 11 — day 7, dose 4
Systemic reaction (other): Generally feel unwell, stuffy nose. Neck and arm ache on side where rash is. Symptoms may be from shingles or the anti- viral I am taking in case I have shingles.
Healthcare visit (other): Yesterday I saw my doctor in an in person visit to show him my rash and today I communicated with him about by symptoms in writing via a messaging system. Yesterday, I mistakenly did not mark the box saying I sought medical attention.
Release 12 — day 35, dose 4
Symptoms: I think I have a wart on my face. I have not gotten care from a healthcare professional yet, but I will probably have a dermatologist remove it.
Release 12 — 3 months, dose 4
Symptoms: Fungal rash, developed a hive in reaction to a tetanus shot - though I've never had that reaction to a tetanus or other shot before.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Not feeling great
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 | Physiotherapy | · | · | ✓ |
| HCVO | Rash | · | · | ✓ |
| SD | Accident | · | · | ✓ |
| SD | Fungal skin infection | · | · | ✓ |
| SD | Hand fracture | · | · | ✓ |
| SD | Ligament sprain | · | · | ✓ |
| SD | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Urticaria | · | · | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Herpes zoster | · | · | ✓ |
| SRO | Insomnia | · | · | ✓ |
| SRO | Malaise | · | · | ✓ |
| SRO | Nasal congestion | · | · | ✓ |
| SRO | Neck pain | · | · | ✓ |
| SRO | Office visit | · | · | ✓ |
| SRO | Oropharyngeal pain | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Rash | · | · | ✓ |
| SRO | Self-medication | · | · | ✓ |
| SRO | Tinnitus | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release