5FJ-27104-15899
5 vaccinations
2 coded responses
30 check-ins
2 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 786 / TX
- Registered
- 2021-01-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-22
Dose 1 — Moderna
-
2021-01-23
Registered in v-safe
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-27
- 2021-01-28
- 2021-02-01
- 2021-02-05
- 2021-02-15
- 2021-02-20
-
2021-02-26
Dose 2 — Moderna
- 2021-02-26
- 2021-02-28
- 2021-03-02
- 2021-03-05
- 2021-03-12
- 2021-03-20
- 2021-03-28
- 2021-04-02
- 2021-04-10
- 2021-05-28
- 2021-08-27
-
2021-10-13
Dose 3 — ModernaCo-administered: Flu
- 2021-10-27
- 2021-11-03
- 2021-11-11
- 2021-11-19
- 2021-11-24
- 2022-01-14
- 2022-04-13
-
2022-05-20
Dose 4 — Moderna
-
2022-06-24
Survey response — day 35, dose 4MedDRA: C-reactive protein increased, Office visit, Pain, Pain in extremity — Feeling: Poor · 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: Symptoms: Pain in vaccine arm after 1 week then pain in other arm then generalized pain. Abnormal lab, C-Reactive Protein 57.3. Dr treating me with Prednisone. Diagnosed with Possible Polymyalgia Rheumatica. Possible immune reaction post vaccine. · Healthcare visit (other): Dr office and labsMedDRA releases: 2024-11 · check-in free text available
-
2022-06-24
Report sent to call center — day 35, dose 4Be 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)
-
2022-06-27
Call successfulParticipant prefers to complete VAERS report online
-
2022-08-19
Survey response — 3 months, dose 4MedDRA: C-reactive protein increased, Myalgia, Office visit, Polymyalgia rheumatica — 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: New diagnosis of Polymyalgia Rheumatic. Muscle pain. CRP was 57. Dr said it may be an immune reaction to last booster. My mother and brother had same Dx which was not related to any vaccine. CDC already called me.MedDRA releases: 2024-11 · check-in free text available
-
2022-08-19
Report sent to call center — 3 months, dose 4Be 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)
- 2022-08-23
- 2022-11-21
-
2023-01-13
Dose 5 — Janssen/Johnson & Johnson
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-02-26 | Moderna | |
| 3 | 2021-10-13 | Moderna | Flu |
| 4 | 2022-05-20 | Moderna | No |
| 5 | 2023-01-13 | Janssen/Johnson & Johnson | No |
Call center
2 call center cases
1 successful · 1 unsuccessful
Free text
Release 12 — day 35, dose 4
Symptoms: Pain in vaccine arm after 1 week then pain in other arm then generalized pain. Abnormal lab, C-Reactive Protein 57.3. Dr treating me with Prednisone. Diagnosed with Possible Polymyalgia Rheumatica. Possible immune reaction post vaccine.
Healthcare visit (other): Dr office and labs
Release 12 — 3 months, dose 4
Symptoms: New diagnosis of Polymyalgia Rheumatic. Muscle pain. CRP was 57. Dr said it may be an immune reaction to last booster. My mother and brother had same Dx which was not related to any vaccine. CDC already called me.
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 | C-reactive protein increased | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Polymyalgia rheumatica | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release