5AH-29768-80367
3 vaccinations
3 coded responses
36 check-ins
1 free-text entry
2 call cases
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 201 / VA
- Registered
- 2022-12-28
- Relationship
- Child or adolescent in my care
- Guardian
- VRA-21570-00730
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-12-28
Registered in v-safe
-
2022-12-28
Dose 1 — ModernaCo-administered: Flu:Hib:Other:Polio:Rotavirus:Tetanus
- 2022-12-28
-
2022-12-29
Health check-in — days 1–6 daily, dose 1, under 3Feeling: Fair · Sleepiness, Loss of appetite · Be unable to do your normal daily activitiesUnder 3 check-in
-
2022-12-30
Survey response — days 1–6 daily, dose 1, under 3MedDRA: Insomnia — Feeling: Fair · Site: Swelling/hardness · Irritability/cryingFree text: Struggled to sleepMedDRA releases: 2024-11 · check-in free text available
-
2022-12-31
Health check-in — days 1–6 daily, dose 1, under 3Feeling: Good · Site: Swelling/hardness · NoneUnder 3 check-in
- 2023-01-01
- 2023-01-02
- 2023-01-03
- 2023-01-04
- 2023-01-11
- 2023-01-18
- 2023-01-25
-
2023-01-27
Dose 2 — ModernaCo-administered: Flu
- 2023-01-27
- 2023-01-28
-
2023-01-29
Health check-in — days 1–6 daily, dose 2, under 3Feeling: Good · Site: Redness · NoneUnder 3 check-in
-
2023-01-30
Health check-in — days 1–6 daily, dose 2, under 3Feeling: Good · Site: Redness · NoneUnder 3 check-in
- 2023-01-31
- 2023-02-01
- 2023-02-02
- 2023-02-03
- 2023-02-10
- 2023-02-17
- 2023-02-24
- 2023-03-03
- 2023-03-10
-
2023-04-03
Dose 3 — Moderna
-
2023-04-04
Health check-in — days 1–6 daily, dose 3, under 3Feeling: Fair · Site: Pain, Redness, Swelling/hardness · Sleepiness, Irritability/crying · Be unable to do your normal daily activitiesUnder 3 check-in
-
2023-04-05
Health check-in — days 1–6 daily, dose 3, under 3Feeling: Fair · Site: Pain, Swelling/hardness · Fever · Irritability/crying, Loss of appetite · Be unable to do your normal daily activitiesUnder 3 check-in
-
2023-04-06
Health check-in — days 1–6 daily, dose 3, under 3Feeling: Fair · Site: Pain, Swelling/hardness · Irritability/cryingUnder 3 check-in
-
2023-04-07
Health check-in — days 1–6 daily, dose 3, under 3Feeling: Fair · Irritability/cryingUnder 3 check-in
- 2023-04-08
-
2023-04-09
Health check-in — days 1–6 daily, dose 3, under 3Feeling: Fair · Irritability/cryingUnder 3 check-in
- 2023-04-10
- 2023-04-17
-
2023-04-24
Survey response — day 21, dose 3, under 3MedDRA: Office visit, Pyrexia — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalMedDRA releases: 2024-11
-
2023-04-24
Report sent to call center — day 21, dose 3, under 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2023-04-25
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-05-01
- 2023-05-08
-
2023-05-15
Survey response — day 42, dose 3, under 3MedDRA: Conjunctivitis, Ear infection, Office visit — 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 professionalMedDRA releases: 2024-11
-
2023-05-15
Report sent to call center — day 42, dose 3, under 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2023-05-16
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-12-28 | Moderna | Flu:Hib:Other:Polio:Rotavirus:Tetanus |
| 2 | 2023-01-27 | Moderna | Flu |
| 3 | 2023-04-03 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2023-04-24 | Successful 2023-04-25 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-05-15 | Unsuccessful |
Free text
Release 12 (Under 3) — days 1–6 daily, dose 1, under 3
Systemic reaction (other): Struggled to sleep
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 |
|---|---|---|---|---|
| HCVO | Office visit | · | · | ✓ |
| SD | Conjunctivitis | · | · | ✓ |
| SD | Ear infection | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SRO | Insomnia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release