5NW-85575-03337
4 vaccinations
9 coded responses
38 check-ins
8 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 615 / IL
- Registered
- 2021-02-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-02-23
Registered in v-safe
-
2021-02-23
Dose 1 — Moderna
-
2021-02-23
Survey response — day 0, dose 1MedDRA: Injection site pain — Feeling: Good · Muscle or body achesFree text: Slight soreness at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-24
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: Pain · Muscle or body achesFree text: Local pain at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
-
2021-03-24
Dose 2 — Moderna
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-03-30
- 2021-03-31
- 2021-04-07
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-05-05
-
2021-06-23
Survey response — 3 months, dose 2MedDRA: Arthralgia, Fatigue, Headache, Neck pain, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: GoodFree text: Fatigue, head, neck and joint pain. Congestion. Tested for COVID19; negative.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-09-22
-
2021-11-23
Dose 3 — Moderna
- 2021-11-30
-
2021-12-07
Survey response — day 14, dose 3MedDRA: Musculoskeletal stiffness — Feeling: GoodFree text: Neck stiffnessMedDRA releases: 2024-11 · check-in free text available
- 2021-12-14
- 2021-12-21
- 2021-12-28
- 2022-01-04
- 2022-02-22
-
2022-04-05
Dose 4 — Moderna
-
2022-04-19
Survey response — day 14, dose 4MedDRA: Injection site pain — Feeling: FairFree text: Just localized pain at the injection site.MedDRA releases: 2024-11 · check-in free text available
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2022-04-26
Survey response — day 21, dose 4MedDRA: Chest discomfort, Nasopharyngitis, Oropharyngeal pain — Feeling: FairFree text: Irritated chest, sore throat. I do not believe these are Covid related. Suspect regular cold virus, possibly Norovirus or similar.MedDRA releases: 2024-11 · check-in free text available
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2022-05-03
Survey response — day 28, dose 4MedDRA: Adverse reaction, Nasopharyngitis, SARS-CoV-2 test negative, Self-medication — Feeling: FairFree text: Cold virus. Quick Covid test was negative. Mild symptoms, about 8 days this far. OTC keeping it in check.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-10
- 2022-05-17
- 2022-07-05
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2022-10-06
Survey response — 6 months, dose 4MedDRA: COVID-19, SARS-CoV-2 test, SARS-CoV-2 test negative, Unevaluable event, Viral infection — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Symptoms: Covid related 8/22/22-8/26/22. Covid + prescribed Paxlovid treatment 8/23/22. Trailed by 8/28/22. Contracted viral infection 10/1/22. Symptom more than mild. Prescribed OTC and Tessalon. Tested Covid negative twice (quick test). PRC test pending. · Healthcare visit (other): Current health is > mild symptom. Suspect non Covid virus. Not confirm yet.MedDRA releases: 2024-11 · check-in free text available
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2022-10-06
Report sent to call center — 6 months, dose 4Be unable to work or attend school · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-10-07
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2023-04-05
Survey response — 12 months, dose 4MedDRA: Dyspnoea, Heart rate irregular, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
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2023-04-05
Report sent to call center — 12 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-04-06
- 2023-04-11
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2023-04-11
Callback requested for12:30PM ET
-
2023-04-11
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-23 | Moderna | |
| 2 | 2021-03-24 | Moderna | |
| 3 | 2021-11-23 | Moderna | No |
| 4 | 2022-04-05 | Moderna | No |
Call center
2 call center cases
2 successful
Free text
Release 4 — day 0, dose 1
Systemic reaction (other): Slight soreness at injection site
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Local pain at injection site
Release 9 — 3 months, dose 2
Symptoms: Fatigue, head, neck and joint pain. Congestion. Tested for COVID19; negative.
Release 10 — day 14, dose 3
Symptoms: Neck stiffness
Release 11 — day 14, dose 4
Symptoms: Just localized pain at the injection site.
Release 11 — day 21, dose 4
Symptoms: Irritated chest, sore throat. I do not believe these are Covid related. Suspect regular cold virus, possibly Norovirus or similar.
Release 11 — day 28, dose 4
Symptoms: Cold virus. Quick Covid test was negative. Mild symptoms, about 8 days this far. OTC keeping it in check.
Release 12 — 6 months, dose 4
Symptoms: Covid related 8/22/22-8/26/22. Covid + prescribed Paxlovid treatment 8/23/22. Trailed by 8/28/22. Contracted viral infection 10/1/22. Symptom more than mild. Prescribed OTC and Tessalon. Tested Covid negative twice (quick test). PRC test pending. cut off by CDC
Healthcare visit (other): Current health is > mild symptom. Suspect non Covid virus. Not confirm yet.
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 | Unevaluable event | · | · | ✓ |
| SD | Adverse reaction | · | · | ✓ |
| SD | Arthralgia | ✓ | ✓ | ✓ |
| SD | Chest discomfort | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Heart rate irregular | · | · | ✓ |
| SD | Injection site pain | · | · | ✓ |
| SD | Musculoskeletal stiffness | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Neck pain | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Respiratory tract congestion | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test | · | · | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SD | Self-medication | · | · | ✓ |
| SD | Viral infection | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release