55X-16208-84137
3 vaccinations
8 coded responses
39 check-ins
8 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 724 / AR
- Registered
- 2021-03-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-23
Registered in v-safe
-
2021-03-23
Dose 1 — Moderna
- 2021-03-23
-
2021-03-24
Survey response — days 1–6 daily, dose 1MedDRA: Condition aggravated, Pre-existing disease — Feeling: Good · Site: Pain, Swelling · HeadacheFree text: I am in my early spring allergy sinus problem season. Its worse while Oak and pecan trees are in pollinationMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-25
- 2021-03-26
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-03-30
- 2021-04-06
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2021-04-13
Survey response — day 21, dose 1MedDRA: Renal pain — Feeling: GoodFree text: My kidneys hurt for four or five days probably because I started drinking cokes again. Went back to water and my kidneys are not hurting anymore.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-20
Dose 2 — Moderna
-
2021-04-20
Survey response — day 0, dose 2MedDRA: Hypersensitivity, Sinus disorder — Feeling: GoodFree text: Sinus/allergy issues Normal for this time of yearMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-21
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Swelling · Fever · Headache, Fatigue or tiredness · Be unable to workAdult check-in
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2021-04-22
Survey response — days 1–6 daily, dose 2MedDRA: Body temperature increased — Feeling: Good · Site: Redness, Swelling, ItchingFree text: My temp Fluctuated between 97.6 which is Normal for me at 99.9 over the first 36 hours after the shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-23
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Swelling · NoneAdult check-in
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2021-04-24
Survey response — days 1–6 daily, dose 2MedDRA: Nodule — Feeling: Good · Site: SwellingFree text: The swelling Ive been reporting is more a knot than swellingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-25
- 2021-04-26
- 2021-04-27
- 2021-05-04
- 2021-05-11
- 2021-05-18
- 2021-05-25
- 2021-06-01
- 2021-07-20
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2021-10-19
Survey response — 6 months, dose 2MedDRA: COVID-19, Influenza, Nasopharyngitis, Pyrexia — 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: Diagnosed with Covid September 12. Full-blown cold/flu symptoms with fever 100.9 at its peakMedDRA releases: 2024-11 · check-in free text available
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2021-10-19
Report sent to call center — 6 months, dose 2Be 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)
- 2021-10-22
- 2021-10-27
-
2021-12-22
Dose 3 — Moderna
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2021-12-23
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
- 2021-12-24
- 2021-12-25
- 2021-12-26
- 2021-12-27
- 2021-12-28
- 2021-12-29
- 2022-01-05
- 2022-01-12
- 2022-01-19
- 2022-01-26
- 2022-02-02
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2022-03-23
Survey response — 3 months, dose 3MedDRA: Cellulitis — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Cellulitis in legMedDRA releases: 2024-11 · check-in free text available
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2022-03-23
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2022-03-24
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2022-03-24
Call successfulParticipant prefers to complete VAERS report online
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2022-06-22
Survey response — 6 months, dose 3MedDRA: Cough, Pyrexia, Sinus disorder, Sneezing — 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 · Outpatient clinic or urgent care clinic visitFree text: Low fever, sinuses going crazy & cough sneezingMedDRA releases: 2024-11 · check-in free text available
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2022-06-22
Report sent to call center — 6 months, dose 3Be 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)
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2022-06-23
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-23 | Moderna | |
| 2 | 2021-04-20 | Moderna | |
| 3 | 2021-12-22 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): I am in my early spring allergy sinus problem season. Its worse while Oak and pecan trees are in pollination
Release 7 — day 21, dose 1
Symptoms: My kidneys hurt for four or five days probably because I started drinking cokes again. Went back to water and my kidneys are not hurting anymore.
Release 7 — day 0, dose 2
Systemic reaction (other): Sinus/allergy issues Normal for this time of year
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): My temp Fluctuated between 97.6 which is Normal for me at 99.9 over the first 36 hours after the shot
Systemic reaction (other): The swelling Ive been reporting is more a knot than swelling
Release 10 — 6 months, dose 2
Symptoms: Diagnosed with Covid September 12. Full-blown cold/flu symptoms with fever 100.9 at its peak
Release 11 — 3 months, dose 3
Symptoms: Cellulitis in leg
Release 12 — 6 months, dose 3
Symptoms: Low fever, sinuses going crazy & cough sneezing
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 | Cellulitis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Renal pain | ✓ | ✓ | ✓ |
| SD | Sinus disorder | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Body temperature increased | ✓ | ✓ | ✓ |
| SRO | Condition aggravated | ✓ | ✓ | ✓ |
| SRO | Hypersensitivity | ✓ | ✓ | ✓ |
| SRO | Nodule | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Sinus disorder | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release