5DM-22544-02293
4 vaccinations
4 coded responses
39 check-ins
4 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 100 / NY
- Registered
- 2021-03-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-02
Dose 1 — Moderna
-
2021-03-03
Registered in v-safe
-
2021-03-03
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Swelling · Muscle or body achesAdult check-in
-
2021-03-04
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fever · Fatigue or tirednessAdult check-in
- 2021-03-05
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
-
2021-03-31
Dose 2 — Moderna
- 2021-03-31
-
2021-04-01
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-02
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Swelling · Fatigue or tirednessAdult check-in
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-05-05
- 2021-05-12
- 2021-06-30
- 2021-09-29
-
2021-11-11
Dose 3 — Moderna
-
2022-03-31
Survey response — 12 months, dose 2MedDRA: Office visit, Rash — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Skin rash on various parts of my body · Healthcare visit (other): Office visit to my dermatologistMedDRA releases: 2024-11 · check-in free text available
-
2022-03-31
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2022-04-05
-
2022-04-11
Call successfulDoes not wish to fill out VAERS report
-
2022-05-13
Dose 4 — Moderna
- 2022-05-13
-
2022-05-14
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Fever · Chills, HeadacheAdult check-in
- 2022-05-15
- 2022-05-16
- 2022-05-17
- 2022-05-18
- 2022-05-19
- 2022-05-20
- 2022-05-27
- 2022-06-03
-
2022-06-17
Survey response — day 35, dose 4MedDRA: COVID-19 — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Contracted Covid-19 while on vacation in Israel. I had my 2nd booster, 4 in total , shots just 4 weeks prior to travel- Israel required that most recent shot be within 6 mnths and my first booster was administered more than 6 mnths priorMedDRA releases: 2024-11 · check-in free text available
-
2022-06-17
Report sent to call center — day 35, dose 4Be 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)
-
2022-06-21
Call successfulParticipant prefers to complete VAERS report online
- 2022-06-25
-
2022-08-12
Survey response — 3 months, dose 4MedDRA: COVID-19, Pneumonia, Pulmonary embolism — Feeling: Poor · Be unable to do your normal daily activitiesFree text: I contracted covid followed by Pneumonia followed by pulmonary emboli. I have no prior history of either and was in good health. After 2 Moderna shots and 2 boosters, I am thinking very carefully before having ANY further Covid vaccines.MedDRA releases: 2024-11 · check-in free text available
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2022-11-11
Survey response — 6 months, dose 4MedDRA: Pneumonia, Pulmonary embolism — 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 visit, Emergency room or emergency department visitFree text: Pneumonia and pulmonary embolisms in both lungsMedDRA releases: 2024-11 · check-in free text available
-
2022-11-11
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 prOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2022-11-14
- 2022-11-15
-
2022-11-16
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-02 | Moderna | |
| 2 | 2021-03-31 | Moderna | |
| 3 | 2021-11-11 | Moderna | No |
| 4 | 2022-05-13 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 11 — 12 months, dose 2
Symptoms: Skin rash on various parts of my body
Healthcare visit (other): Office visit to my dermatologist
Release 12 — day 35, dose 4
Symptoms: Contracted Covid-19 while on vacation in Israel. I had my 2nd booster, 4 in total , shots just 4 weeks prior to travel- Israel required that most recent shot be within 6 mnths and my first booster was administered more than 6 mnths prior
Release 12 — 3 months, dose 4
Symptoms: I contracted covid followed by Pneumonia followed by pulmonary emboli. I have no prior history of either and was in good health. After 2 Moderna shots and 2 boosters, I am thinking very carefully before having ANY further Covid vaccines.
Release 12 — 6 months, dose 4
Symptoms: Pneumonia and pulmonary embolisms in both lungs
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 | COVID-19 | · | · | ✓ |
| SD | Pneumonia | · | · | ✓ |
| SD | Pulmonary embolism | · | · | ✓ |
| SD | Rash | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release