54E-32934-55700
6 vaccinations
6 coded responses
55 check-ins
6 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 113 / NY
- Registered
- 2021-02-14
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-14
Registered in v-safe
-
2021-02-14
Dose 1 — Moderna
- 2021-02-14
- 2021-02-15
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-21
- 2021-02-28
- 2021-03-07
- 2021-03-14
-
2021-03-15
Dose 2 — Moderna
-
2021-03-15
Survey response — day 0, dose 2MedDRA: Feeling cold — Feeling: GoodFree text: I felt cold, so I put on a heavy shirt. I felt warmer in less than an hour. I feel fine, now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-16
Survey response — days 1–6 daily, dose 2MedDRA: Pain in extremity — Feeling: GoodFree text: Just a bit of a sore arm, but not bad, though.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-22
- 2021-03-29
- 2021-04-05
- 2021-04-12
- 2021-04-24
- 2021-04-26
- 2021-06-14
- 2021-09-14
-
2021-10-22
Dose 3 — Moderna
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: I feel fine!MedDRA releases: 2024-11 · check-in free text available
- 2021-11-05
- 2021-11-15
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2022-01-21
-
2022-04-01
Dose 4 — Moderna
- 2022-04-18
- 2022-04-23
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-07-01
-
2022-09-26
Dose 5 — Moderna
- 2022-09-30
- 2022-09-30
- 2022-10-01
- 2022-10-02
- 2022-10-03
- 2022-10-10
- 2022-10-17
-
2022-10-25
Survey response — day 28, dose 5MedDRA: Fatigue, Headache, Pain, Rhinorrhoea — Feeling: Poor · 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: Tired. Runny nose. Achy. Headache.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-25
Report sent to call center — day 28, dose 5Be 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)
-
2022-10-26
Call successfulParticipant prefers to complete VAERS report online
-
2022-10-31
Survey response — day 35, dose 5MedDRA: Laboratory test abnormal — Feeling: Good · 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: PCR test came back positive on October 26,2022MedDRA releases: 2024-11 · check-in free text available
-
2022-10-31
Report sent to call center — day 35, dose 5Be 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)
-
2022-11-01
Call successfulNot applicable - Accidental Reporting
- 2022-11-07
-
2022-12-26
Survey response — 3 months, dose 5MedDRA: COVID-19, Headache, Thrombosis — Feeling: Good · 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: October 21,2022 I contracted COVID 19. Splitting head ache for almost one week. Blood clotting went through the roof. Primary doctor prescribed Xeralto blood thinner. One and a half months to recover fully.MedDRA releases: 2024-11 · check-in free text available
-
2022-12-26
Report sent to call center — 3 months, dose 5Be 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)
-
2022-12-28
Call successfulParticipant prefers to complete VAERS report online
- 2023-03-28
-
2023-04-23
Dose 6 — Moderna
- 2023-05-08
- 2023-05-14
- 2023-05-21
- 2023-05-28
- 2023-06-04
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-14 | Moderna | |
| 2 | 2021-03-15 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-04-01 | Moderna | No |
| 5 | 2022-09-26 | Moderna | No |
| 6 | 2023-04-23 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 5 — day 0, dose 2
Systemic reaction (other): I felt cold, so I put on a heavy shirt. I felt warmer in less than an hour. I feel fine, now.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Just a bit of a sore arm, but not bad, though.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): I feel fine!
Release 12 — day 28, dose 5
Symptoms: Tired. Runny nose. Achy. Headache.
Release 12 — day 35, dose 5
Symptoms: PCR test came back positive on October 26,2022
Release 12 — 3 months, dose 5
Symptoms: October 21,2022 I contracted COVID 19. Splitting head ache for almost one week. Blood clotting went through the roof. Primary doctor prescribed Xeralto blood thinner. One and a half months to recover fully.
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 |
|---|---|---|---|---|
| SD | COVID-19 | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Laboratory test abnormal | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Thrombosis | · | · | ✓ |
| SRO | Feeling cold | ✓ | ✓ | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release