557-57875-09315
4 vaccinations
12 coded responses
53 check-ins
11 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 921 / CA
- Registered
- 2021-03-14
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-14
Registered in v-safe
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2021-03-14
Dose 1 — Janssen/Johnson & Johnson
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2021-03-14
Survey response — day 0, dose 1MedDRA: Contusion — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Slight bruisingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-16
Survey response — days 1–6 daily, dose 1MedDRA: Eye irritation — Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Irritated eyeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-17
Survey response — days 1–6 daily, dose 1MedDRA: Eye irritation, Oral herpes — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Cold sore on lip and irritated eye (both left)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-28
- 2021-04-04
- 2021-04-11
- 2021-04-19
- 2021-04-25
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2021-06-13
Survey response — 3 months, dose 1MedDRA: Hypertension — Feeling: GoodFree text: High blood pressureMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-09-12
Survey response — 6 months, dose 1MedDRA: Gleason grading score, Prostate cancer — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Low grade prostate cancer (gleason 3+3) diagnosed mid-May. Probably long-existing.MedDRA releases: 2024-11 · check-in free text available
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2021-09-12
Report sent to call center — 6 months, dose 1Get care from a doctor or other healthcare professional1 call case(s)
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2021-09-16
Call successfulDoes not wish to fill out VAERS report
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2021-11-01
Dose 2 — Moderna
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2021-11-03
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-04
- 2021-11-05
- 2021-11-06
- 2021-11-07
- 2021-11-08
- 2021-11-15
-
2021-11-22
Survey response — day 21, dose 2MedDRA: Cough, Sneezing — Feeling: GoodFree text: Some sneezing and a little coughing.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-29
- 2021-12-06
- 2021-12-13
- 2022-01-31
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2022-04-06
Dose 3 — Moderna
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2022-04-07
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-04-08
Health check-in — days 1–6 daily, dose 3Feeling: Good · Fatigue or tiredness, DiarrheaAdult check-in
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2022-04-09
Health check-in — days 1–6 daily, dose 3Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-04-10
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesAdult check-in
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2022-04-11
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, DiarrheaAdult check-in
- 2022-04-12
- 2022-04-13
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2022-04-20
Survey response — day 14, dose 3MedDRA: Ear pain — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: earache, right sideMedDRA releases: 2024-11 · check-in free text available
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2022-04-20
Report sent to call center — day 14, dose 3Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
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2022-04-21
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-04-27
- 2022-05-04
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2022-05-11
Survey response — day 35, dose 3MedDRA: Back pain — Feeling: FairFree text: Lower back painMedDRA releases: 2024-11 · check-in free text available
- 2022-05-18
- 2022-07-06
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2022-09-20
Dose 4 — Pfizer-BioNTech
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2022-09-21
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-09-22
Survey response — days 1–6 daily, dose 4MedDRA: Cough — Feeling: Fair · Site: Pain · Fever · Muscle or body aches, Fatigue or tirednessFree text: coughMedDRA releases: 2024-11 · check-in free text available
- 2022-09-23
- 2022-09-24
- 2022-09-25
- 2022-09-26
- 2022-09-27
- 2022-10-04
- 2022-10-11
- 2022-10-18
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2022-10-25
Survey response — day 35, dose 4MedDRA: Oropharyngeal pain, SARS-CoV-2 test negative, Sneezing — Feeling: GoodFree text: Sneezing, very mild sore throat. Covid antigen tests all negativeMedDRA releases: 2024-11 · check-in free text available
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2022-11-02
Survey response — day 42, dose 4MedDRA: Condition aggravated, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Trigeminal neuralgia episode, been having them for years, almost certainly not related to covid vaccine.MedDRA releases: 2024-11 · check-in free text available
- 2022-12-20
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2023-03-21
Survey response — 6 months, dose 4MedDRA: Procedural intestinal perforation, Prostatectomy, Reproductive tract procedural complication — 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 · Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11
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2023-03-21
Report sent to call center — 6 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · Hospitalization · 1 call case(s)
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2023-03-22
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-14 | Janssen/Johnson & Johnson | |
| 2 | 2021-11-01 | Moderna | No |
| 3 | 2022-04-06 | Moderna | No |
| 4 | 2022-09-20 | Pfizer-BioNTech | No |
Call center
3 call center cases
3 successful
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): Slight bruising
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Irritated eye
Systemic reaction (other): Cold sore on lip and irritated eye (both left)
Release 9 — 3 months, dose 1
Symptoms: High blood pressure
Release 9 — 6 months, dose 1
Symptoms: Low grade prostate cancer (gleason 3+3) diagnosed mid-May. Probably long-existing.
Release 10 — day 21, dose 2
Symptoms: Some sneezing and a little coughing.
Release 11 — day 14, dose 3
Symptoms: earache, right side
Release 11 — day 35, dose 3
Symptoms: Lower back pain
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): cough
Release 12 — day 35, dose 4
Symptoms: Sneezing, very mild sore throat. Covid antigen tests all negative
Release 12 — day 42, dose 4
Symptoms: Trigeminal neuralgia episode, been having them for years, almost certainly not related to covid vaccine.
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 | Back pain | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Ear pain | · | · | ✓ |
| SD | Gleason grading score | · | · | ✓ |
| SD | Hypertension | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Procedural intestinal perforation | · | · | ✓ |
| SD | Prostate cancer | · | · | ✓ |
| SD | Prostatectomy | · | · | ✓ |
| SD | Reproductive tract procedural complication | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Contusion | ✓ | ✓ | ✓ |
| SRO | Cough | · | · | ✓ |
| SRO | Eye irritation | ✓ | ✓ | ✓ |
| SRO | Oral herpes | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release