54V-94095-91164
5 vaccinations
13 coded responses
67 check-ins
11 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 605 / IL
- Registered
- 2021-02-27
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-27
Registered in v-safe
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2021-02-27
Dose 1 — Moderna
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2021-02-27
Health check-in — day 0, dose 1Feeling: Good · Site: Pain, Itching · Headache, Fatigue or tirednessAdult check-in
- 2021-02-28
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2021-03-01
Survey response — days 1–6 daily, dose 1MedDRA: Abdominal pain, Dyspepsia, Faeces discoloured — Feeling: GoodFree text: Abdominal pain and dyspepsia with green stools last night None todayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-02
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2021-03-03
Survey response — days 1–6 daily, dose 1MedDRA: Abdominal pain — Feeling: Good · Abdominal painFree text: Fleeting abdominal pain not sure if related to vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-04
Survey response — days 1–6 daily, dose 1MedDRA: Erythema, Mouth ulceration — Feeling: GoodFree text: Left buccal mucosa redness and pinpoint ulcers for 24 hours Not sure if its associatedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-05
- 2021-03-06
- 2021-03-13
- 2021-03-20
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2021-03-29
Dose 2 — Moderna
- 2021-03-29
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2021-03-30
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction — Feeling: Good · Site: Pain · Chills, Fatigue or tiredness, Abdominal painFree text: Mostly last nightMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-31
Health check-in — days 1–6 daily, dose 2Feeling: Good · Fatigue or tiredness, Abdominal painAdult check-in
- 2021-04-01
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2021-04-02
Survey response — days 1–6 daily, dose 2MedDRA: Oropharyngeal pain — Feeling: Good · Headache, Muscle or body achesFree text: Sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-12
- 2021-04-19
- 2021-04-26
- 2021-05-03
- 2021-05-10
- 2021-06-28
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2021-09-27
Survey response — 6 months, dose 2MedDRA: Pre-existing disease, Seasonal allergy — Feeling: GoodFree text: Hay fever like symptoms since July persistent despite Allegra Maybe just allergies but did not have this in previous years Otherwise okay I am a physician did not seek other medical careMedDRA releases: 2024-11 · check-in free text available
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2021-10-31
Dose 3 — Moderna
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2021-10-31
Survey response — day 0, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2021-11-01
Survey response — days 1–6 daily, dose 3MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Sore throatMedDRA releases: 2024-11 · check-in free text available
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
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2021-11-06
Survey response — days 1–6 daily, dose 3MedDRA: Migraine — Feeling: Fair · Fever · Headache · Be unable to do your normal daily activitiesFree text: Since yesterday migraine like headache lasting over 24 hoursMedDRA releases: 2024-11 · check-in free text available
- 2021-11-07
- 2021-11-14
- 2021-11-21
- 2021-11-29
- 2021-12-05
- 2021-12-12
- 2022-01-30
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2022-04-22
Dose 4 — Moderna
- 2022-04-22
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2022-04-23
Survey response — days 1–6 daily, dose 4MedDRA: Adverse reaction — Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Symptoms started about 12 hours after receiving the shotMedDRA releases: 2024-11 · check-in free text available
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2022-04-24
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Itching · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2022-04-25
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2022-04-26
Health check-in — days 1–6 daily, dose 4Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-04-27
- 2022-04-28
- 2022-05-01
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2022-05-06
Survey response — day 14, dose 4MedDRA: Tinnitus — Feeling: GoodFree text: Mild tinnitus for past 5 days Sudden development Not sure if it's connected Will monitorMedDRA releases: 2024-11 · check-in free text available
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-06-03
- 2022-07-22
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2022-10-03
Dose 5 — Pfizer-BioNTech
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2022-10-04
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2022-10-05
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain · Joint pains, Fatigue or tirednessAdult check-in
- 2022-10-06
- 2022-10-07
- 2022-10-08
- 2022-10-09
- 2022-10-10
- 2022-10-17
- 2022-10-24
- 2022-11-01
- 2022-11-08
- 2022-11-14
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2023-01-02
Survey response — 3 months, dose 5MedDRA: Nasal congestion, Rhinorrhoea, SARS-CoV-2 test negative, Sneezing — Feeling: Good · Be unable to do your normal daily activitiesMedDRA releases: 2024-11
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2023-04-03
Survey response — 6 months, dose 5MedDRA: COVID-19 — 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 consultationMedDRA releases: 2024-11
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2023-04-03
Report sent to call center — 6 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)
- 2023-04-04
- 2023-04-19
- 2023-04-20
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2023-04-20
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-27 | Moderna | |
| 2 | 2021-03-29 | Moderna | |
| 3 | 2021-10-31 | Moderna | No |
| 4 | 2022-04-22 | Moderna | No |
| 5 | 2022-10-03 | Pfizer-BioNTech | No |
Call center
1 call center case
1 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Abdominal pain and dyspepsia with green stools last night None today
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Fleeting abdominal pain not sure if related to vaccine
Systemic reaction (other): Left buccal mucosa redness and pinpoint ulcers for 24 hours Not sure if its associated
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Mostly last night
Systemic reaction (other): Sore throat
Release 9 — 6 months, dose 2
Symptoms: Hay fever like symptoms since July persistent despite Allegra Maybe just allergies but did not have this in previous years Otherwise okay I am a physician did not seek other medical care
Release 10 — day 0, dose 3
Systemic reaction (other): No
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Sore throat
Systemic reaction (other): Since yesterday migraine like headache lasting over 24 hours
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Symptoms started about 12 hours after receiving the shot
Release 11 — day 14, dose 4
Symptoms: Mild tinnitus for past 5 days Sudden development Not sure if it's connected Will monitor
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 | Nasal congestion | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Seasonal allergy | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Tinnitus | · | · | ✓ |
| SRO | Abdominal pain | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | ✓ | ✓ | ✓ |
| SRO | Dyspepsia | ✓ | ✓ | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Faeces discoloured | ✓ | ✓ | ✓ |
| SRO | Migraine | · | · | ✓ |
| SRO | Mouth ulceration | ✓ | ✓ | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release