5JU-67869-44612
3 vaccinations
12 coded responses
34 check-ins
12 free-text entries
8 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 740 / OK
- Registered
- 2021-01-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-01-21
Dose 1 — Moderna
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2021-01-24
Registered in v-safe
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-02-04
- 2021-02-11
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2021-02-20
Survey response — day 28, dose 1MedDRA: Deafness unilateral, Vertigo, Vomiting — Feeling: Poor · Be unable to work, 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: Vertigo issues with my sudden hearing loss in the right ear. Threw up one time only.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-20
Report sent to call center — day 28, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-02-25
Survey response — day 35, dose 1MedDRA: Nephrolithiasis, Office visit — Feeling: Poor · Be unable to work, 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: Kidney stone · Healthcare visit (other): PCP in-office visit. I am scheduled for 2nd Moderna vaccination next week 3/2.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-25
Report sent to call center — day 35, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-03-02
Dose 2 — Moderna
- 2021-03-04
- 2021-03-05
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2021-03-06
Survey response — days 1–6 daily, dose 2MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-07
- 2021-03-08
- 2021-03-09
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2021-03-16
Survey response — day 14, dose 2MedDRA: Decreased appetite, Headache, Influenza, Insomnia — Feeling: Poor · Be unable to work, 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: I was tested for Covid and A&B Flu at the hospital. All results were negative. It is a virus. Headache that wont go away, no appetite, threw up once, cant sleep.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-16
Report sent to call center — day 14, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-03-23
Survey response — day 21, dose 2MedDRA: Constipation, Cough, Decreased appetite, Headache, Influenza A virus test negative, Influenza virus test negative, Insomnia, Nausea, Pyrexia, SARS-CoV-2 test negative — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree text: Constant headaches, low-grade fever, no appetite, constipation, dry hacking cough, Nausea and cant sleep well. Ive had these symptoms now for over a week. Was just tested with the Bio Fire test for Covid and the Flu A & B and all were negative.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-30
Survey response — day 28, dose 2MedDRA: Balance disorder, Deafness unilateral, Decreased appetite, Fatigue, Malaise — Feeling: Fair · Be unable to work, 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: Fatigue, no appetite, general yuk feeling. Still 100% hearing loss in right ear with poor equilibrium.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-30
Report sent to call center — day 28, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-06
- 2021-04-13
- 2021-06-01
- 2021-08-11
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2021-08-31
Survey response — 6 months, dose 2MedDRA: Cough, Fatigue, Nasopharyngitis, Respiratory tract congestion, Rhinorrhoea, Throat irritation — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Common cold symptoms, scratchy throat, congestion, slight cough, blowing nose a lot, tires easily.MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-11-18
Dose 3 — Moderna
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2021-11-18
Survey response — day 0, dose 3MedDRA: Injection site pain — Feeling: Good · Site: PainFree text: Sore arm where I received the boosterMedDRA releases: 2024-11 · check-in free text available
- 2021-11-19
- 2021-11-20
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2021-11-22
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Already reportedMedDRA releases: 2024-11 · check-in free text available
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2021-11-22
Report sent to call center — days 1–6 daily, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
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2021-11-22
Call successfulNot applicable - Accidental Reporting
- 2021-11-24
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2021-12-02
Survey response — day 14, dose 3MedDRA: Condition aggravated, Cough, Headache, Influenza virus test negative, Malaise, Office visit, Oropharyngeal pain, Pre-existing disease, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative — 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: 10 days after booster, I developed my 2nd kidney stone ever. 1st was after Moderna vaccine in Jan. Also became sick, still am. Saw doctor yesterday, tested NEGATIVE for the Flu and Covid. Running low fever, congestion, cough, headache, sore throat.MedDRA releases: 2024-11 · check-in free text available
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2021-12-02
Report sent to call center — day 14, dose 3Be 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)
- 2021-12-06
- 2021-12-09
- 2021-12-16
- 2021-12-23
- 2021-12-30
- 2022-02-17
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2022-05-19
Survey response — 6 months, dose 3MedDRA: Arthralgia, Arthritis, Asthenia, Fatigue, Musculoskeletal stiffness, Office visit, Pain in extremity — 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: Symptoms: Not new symptoms, haven't reported these before. Weakness, tiredness and stiffness in legs; pain in knee & hip joints. Have seen PCP and Orthopedic doctor. Said was arthritis. But the pain not just in my joints, but in both legs and hips all the way. · Healthcare visit (other): Saw my PCP and Orthopedic docs in person. Also saw my chiropractor and a neurologist.MedDRA releases: 2024-11 · check-in free text available
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2022-05-19
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)
- 2022-05-20
- 2022-05-20
- 2022-05-20
- 2022-05-20
- 2022-05-20
- 2022-05-20
- 2022-05-20
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2022-11-18
Survey response — 12 months, dose 3MedDRA: Deafness unilateral, Influenza, Muscular weakness, Musculoskeletal stiffness, Nephrolithiasis — Feeling: Poor · 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: I never reported weakness & stiffness in my legs. Happened after first Moderna vaccine. After I totally lost hearing in right ear, had first ever kidney stone (I'm 67 yrs old). Never any health issues prior. Now have the flu, 1st time since 1978.MedDRA releases: 2024-11 · check-in free text available
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2022-11-18
Report sent to call center — 12 months, dose 3Be 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)
- 2022-11-21
- 2022-11-21
- 2022-11-21
- 2022-11-21
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-21 | Moderna | |
| 2 | 2021-03-02 | Moderna | |
| 3 | 2021-11-18 | Moderna | No |
Call center
8 call center cases
4 successful · 4 unsuccessful
VAERS report filed, before or during a call: 2
4 waits over 3 months for a first call
Free text
Release 4 — day 28, dose 1
Symptoms: Vertigo issues with my sudden hearing loss in the right ear. Threw up one time only.
Release 4 — day 35, dose 1
Symptoms: Kidney stone
Healthcare visit (other): PCP in-office visit. I am scheduled for 2nd Moderna vaccination next week 3/2.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): None
Release 5 — day 14, dose 2
Symptoms: I was tested for Covid and A&B Flu at the hospital. All results were negative. It is a virus. Headache that wont go away, no appetite, threw up once, cant sleep.
Release 6 — day 21, dose 2
Symptoms: Constant headaches, low-grade fever, no appetite, constipation, dry hacking cough, Nausea and cant sleep well. Ive had these symptoms now for over a week. Was just tested with the Bio Fire test for Covid and the Flu A & B and all were negative.
Release 6 — day 28, dose 2
Symptoms: Fatigue, no appetite, general yuk feeling. Still 100% hearing loss in right ear with poor equilibrium.
Release 9 — 6 months, dose 2
Symptoms: Common cold symptoms, scratchy throat, congestion, slight cough, blowing nose a lot, tires easily.
Release 10 — day 0, dose 3
Systemic reaction (other): Sore arm where I received the booster
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Already reported
Release 10 — day 14, dose 3
Symptoms: 10 days after booster, I developed my 2nd kidney stone ever. 1st was after Moderna vaccine in Jan. Also became sick, still am. Saw doctor yesterday, tested NEGATIVE for the Flu and Covid. Running low fever, congestion, cough, headache, sore throat. cut off by CDC
Release 11 — 6 months, dose 3
Symptoms: Not new symptoms, haven't reported these before. Weakness, tiredness and stiffness in legs; pain in knee & hip joints. Have seen PCP and Orthopedic doctor. Said was arthritis. But the pain not just in my joints, but in both legs and hips all the way. cut off by CDC
Healthcare visit (other): Saw my PCP and Orthopedic docs in person. Also saw my chiropractor and a neurologist.
Release 12 — 12 months, dose 3
Symptoms: I never reported weakness & stiffness in my legs. Happened after first Moderna vaccine. After I totally lost hearing in right ear, had first ever kidney stone (I'm 67 yrs old). Never any health issues prior. Now have the flu, 1st time since 1978.
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 | Arthralgia | · | · | ✓ |
| SD | Arthritis | · | · | ✓ |
| SD | Asthenia | · | · | ✓ |
| SD | Balance disorder | ✓ | ✓ | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Constipation | ✓ | ✓ | ✓ |
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Deafness unilateral | ✓ | ✓ | ✓ |
| SD | Decreased appetite | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Influenza | ✓ | ✓ | ✓ |
| SD | Influenza A virus test negative | ✓ | ✓ | ✓ |
| SD | Influenza virus test negative | ✓ | ✓ | ✓ |
| SD | Insomnia | ✓ | ✓ | ✓ |
| SD | Malaise | ✓ | ✓ | ✓ |
| SD | Muscular weakness | · | · | ✓ |
| SD | Musculoskeletal stiffness | · | · | ✓ |
| SD | Nasopharyngitis | ✓ | · | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SD | Nephrolithiasis | ✓ | ✓ | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | ✓ | · | ✓ |
| SD | Rhinorrhoea | ✓ | · | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SD | Throat irritation | ✓ | · | ✓ |
| SD | Vertigo | ✓ | ✓ | ✓ |
| SD | Vomiting | ✓ | ✓ | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release