554-25546-53179
5 vaccinations
11 coded responses
45 check-ins
10 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 303 / GA
- Registered
- 2021-02-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-18
Dose 1 — Moderna
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2021-02-15
Registered in v-safe
-
2021-02-15
Dose 2 — Moderna
- 2021-02-15
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2021-02-16
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Chills, Headache, Fatigue or tiredness, NauseaAdult check-in
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2021-02-17
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
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2021-02-18
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: GoodFree text: Mild DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-19
- 2021-02-21
- 2021-02-22
- 2021-03-01
- 2021-03-08
- 2021-03-15
- 2021-03-22
- 2021-03-29
- 2021-05-17
- 2021-08-16
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2021-10-31
Dose 3 — Moderna
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2021-11-01
Survey response — days 1–6 daily, dose 3MedDRA: Injection site discomfort — Feeling: Good · ChillsFree text: Minor soreness at injection site but not painful.MedDRA releases: 2024-11 · check-in free text available
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2021-11-02
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2024-11 · check-in free text available
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2021-11-03
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2024-11 · check-in free text available
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2021-11-04
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2024-11 · check-in free text available
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2021-11-05
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2024-11 · check-in free text available
- 2021-11-06
- 2021-11-07
- 2021-11-14
- 2021-11-21
- 2021-11-30
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2021-12-05
Survey response — day 35, dose 3MedDRA: Condition aggravated, Pre-existing disease — 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 visitFree text: Sinus infection. I get a lot of sinus infections with fall allergies.MedDRA releases: 2024-11 · check-in free text available
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2021-12-05
Report sent to call center — day 35, dose 3Be 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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2021-12-10
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-12-12
- 2022-01-30
- 2022-05-01
-
2022-05-16
Dose 4 — Moderna
- 2022-05-19
- 2022-05-20
- 2022-05-22
- 2022-05-23
- 2022-05-30
- 2022-06-06
- 2022-06-13
- 2022-06-20
- 2022-06-27
- 2022-08-15
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2022-09-07
Dose 5 — ModernaCo-administered: Flu
- 2022-09-22
- 2022-09-28
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2022-10-07
Survey response — day 28, dose 5MedDRA: Blood pressure increased — Feeling: GoodFree text: Elevated blood pressureMedDRA releases: 2024-11 · check-in free text available
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2022-10-12
Survey response — day 35, dose 5MedDRA: Dysphonia, Oropharyngeal pain — Feeling: GoodFree text: Hoarse, sore throatMedDRA releases: 2024-11 · check-in free text available
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2022-10-19
Survey response — day 42, dose 5MedDRA: Hypertension, Sleep disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: High blood pressure is continuing, as well as sleep disturbances (which may be caused by the high blood pressure). The average is 20-30 points higher on the top number and 10-15 higher on the bottom than the month before I got the boosterMedDRA releases: 2024-11 · check-in free text available
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2022-10-19
Report sent to call center — day 42, dose 5Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-10-20
Call successfulParticipant prefers to complete VAERS report online
- 2022-12-07
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2023-03-09
Survey response — 6 months, dose 5MedDRA: Nasopharyngitis, Urinary tract infection — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
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2023-03-09
Report sent to call center — 6 months, dose 5Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-03-10
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2023-03-10
Callback requested for01:41PM ET
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2023-03-10
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-18 | Moderna | |
| 2 | 2021-02-15 | Moderna | |
| 3 | 2021-10-31 | Moderna | No |
| 4 | 2022-05-16 | Moderna | No |
| 5 | 2022-09-07 | Moderna | Flu |
Call center
3 call center cases
3 successful
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Mild Dizziness
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Minor soreness at injection site but not painful.
Systemic reaction (other): None
Systemic reaction (other): None
Systemic reaction (other): None
Systemic reaction (other): None
Release 10 — day 35, dose 3
Symptoms: Sinus infection. I get a lot of sinus infections with fall allergies.
Release 12 — day 28, dose 5
Symptoms: Elevated blood pressure
Release 12 — day 35, dose 5
Symptoms: Hoarse, sore throat
Release 12 — day 42, dose 5
Symptoms: High blood pressure is continuing, as well as sleep disturbances (which may be caused by the high blood pressure). The average is 20-30 points higher on the top number and 10-15 higher on the bottom than the month before I got the booster
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 | Blood pressure increased | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Dysphonia | · | · | ✓ |
| SD | Hypertension | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Sleep disorder | · | · | ✓ |
| SD | Urinary tract infection | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Injection site discomfort | · | · | ✓ |
| SRO | No adverse event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release