5TH-57263-17394
5 vaccinations
9 coded responses
53 check-ins
8 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 958 / CA
- Registered
- 2021-01-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-19
Registered in v-safe
-
2021-01-19
Dose 1 — Moderna
- 2021-01-19
-
2021-01-22
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: GoodFree text: Your verification codes are very slow to arrive via text to my Verizon wireless cell phone. For surveys for day two and three arrive late in the evening after I went to bed and the link had expired by the time I saw the message the following morning.You need to do better.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-02-02
- 2021-02-09
-
2021-02-16
Dose 2 — Moderna
- 2021-02-16
-
2021-02-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Fatigue or tirednessAdult check-in
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
-
2021-03-23
Survey response — day 35, dose 2MedDRA: Asthenia, Fatigue — Feeling: Good · Be unable to do your normal daily activitiesFree text: Fatigue and lack of energyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-30
- 2021-05-18
-
2021-08-17
Survey response — 6 months, dose 2MedDRA: Paranasal sinus hypersecretion, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Runny nose and sinus discharge · Healthcare visit (other): Got COVID-19 test which was negativeMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-17
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-23
- 2021-08-24
-
2021-08-26
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-08-27
Dose 3 — Moderna
-
2021-08-28
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Headache, Fatigue or tirednessAdult check-in
-
2021-08-29
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-08-30
- 2021-08-31
- 2021-09-01
-
2021-09-02
Survey response — days 1–6 daily, dose 3MedDRA: Middle insomnia, Sleep disorder — Feeling: GoodFree text: Disturbed sleep for the last two nights keeping me awake from 2 am to 5 am.MedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-09-03
- 2021-09-10
- 2021-09-17
- 2021-09-24
- 2021-10-01
- 2021-10-08
- 2021-11-26
-
2022-01-26
Dose 4 — Moderna
- 2022-02-25
- 2022-04-27
-
2022-07-27
Survey response — 6 months, dose 4MedDRA: Exposure to SARS-CoV-2, Respiratory symptom, SARS-CoV-2 test negative — Feeling: GoodFree text: URI symptoms at the same time that my wife tested positive for SARS-CoV-2 on July 15, 2022 by PCR. I have tested negative multiple times since then including two PCR tests. My wife completed her V-Safe check-in today, too.MedDRA releases: 2024-11 · check-in free text available
-
2022-09-02
Dose 5 — Moderna
- 2022-09-02
- 2022-09-03
-
2022-09-04
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-09-05
- 2022-09-06
-
2022-09-08
Survey response — days 1–6 daily, dose 5MedDRA: Rhinorrhoea, Sneezing — Feeling: GoodFree text: Runny nose and sneezingMedDRA releases: 2024-11 · check-in free text available
-
2022-09-09
Survey response — day 7, dose 5MedDRA: SARS-CoV-2 test negative — Feeling: GoodFree text: My SARS-CoV-2 home Rapid antigen test yesterday was negativeMedDRA releases: 2024-11 · check-in free text available
- 2022-09-16
- 2022-09-23
- 2022-09-30
- 2022-10-07
- 2022-10-14
-
2022-12-02
Survey response — 3 months, dose 5MedDRA: Abdominal pain upper, Upper respiratory tract infection — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Upper respiratory infection with stomach ache. Abbott BinaxNOW rapid antigen test negative yesterday afternoon. No cough or fever.MedDRA releases: 2024-11 · check-in free text available
-
2023-03-03
Survey response — 6 months, dose 5MedDRA: COVID-19, Cough, Diarrhoea, Fatigue, Malaise, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationMedDRA releases: 2024-11
-
2023-03-03
Report sent to call center — 6 months, dose 5Be 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)
-
2023-03-06
Call successfulCompleted over the phone
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-19 | Moderna | |
| 2 | 2021-02-16 | Moderna | |
| 3 | 2021-08-27 | Moderna | No |
| 4 | 2022-01-26 | Moderna | No |
| 5 | 2022-09-02 | Moderna | No |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 1
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Your verification codes are very slow to arrive via text to my Verizon wireless cell phone. For surveys for day two and three arrive late in the evening after I went to bed and the link had expired by the time I saw the message the following morning.You need to do better.
Release 6 — day 35, dose 2
Symptoms: Fatigue and lack of energy
Release 9 — 6 months, dose 2
Symptoms: Runny nose and sinus discharge
Healthcare visit (other): Got COVID-19 test which was negative
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): Disturbed sleep for the last two nights keeping me awake from 2 am to 5 am.
Release 12 — 6 months, dose 4
Symptoms: URI symptoms at the same time that my wife tested positive for SARS-CoV-2 on July 15, 2022 by PCR. I have tested negative multiple times since then including two PCR tests. My wife completed her V-Safe check-in today, too.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Runny nose and sneezing
Release 12 — day 7, dose 5
Systemic reaction (other): My SARS-CoV-2 home Rapid antigen test yesterday was negative
Release 12 — 3 months, dose 5
Symptoms: Upper respiratory infection with stomach ache. Abbott BinaxNOW rapid antigen test negative yesterday afternoon. No cough or fever.
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 | SARS-CoV-2 test negative | ✓ | · | ✓ |
| SD | Abdominal pain upper | · | · | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Exposure to SARS-CoV-2 | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Paranasal sinus hypersecretion | ✓ | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Respiratory symptom | · | · | ✓ |
| SD | Rhinorrhoea | ✓ | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Upper respiratory tract infection | · | · | ✓ |
| SRO | Middle insomnia | ✓ | · | ✓ |
| SRO | Rhinorrhoea | · | · | ✓ |
| SRO | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Sleep disorder | ✓ | · | ✓ |
| SRO | Sneezing | · | · | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release