628-27489-62086
3 vaccinations
4 coded responses
24 check-ins
3 free-text entries
1 call case
- Sex
- Female
- Age at first dose
- 31-35
- ZIP prefix
- 537 / WI
- Registered
- 2021-06-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-06-09
Dose 1 — Moderna
-
2021-06-11
Registered in v-safe
- 2021-06-11
- 2021-06-12
- 2021-06-13
- 2021-06-14
-
2021-06-16
Survey response — day 7, dose 1MedDRA: Oropharyngeal pain — Feeling: GoodFree text: Sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-23
- 2021-06-30
-
2021-07-07
Dose 2 — Moderna
- 2021-07-07
- 2021-07-08
- 2021-07-09
- 2021-07-10
- 2021-07-11
- 2021-07-12
- 2021-07-13
- 2021-07-14
- 2021-07-21
- 2021-07-28
- 2021-08-04
- 2021-08-11
-
2021-08-18
Survey response — day 42, dose 2MedDRA: Cough, Nasal congestion, Paranasal sinus discomfort — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Cough, stuffy nose, sinus pressureMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-18
Report sent to call center — day 42, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-22
- 2021-10-06
-
2022-01-05
Survey response — 6 months, dose 2MedDRA: Cough, Ear pain, Headache, Nasal congestion, Oropharyngeal pain, Pain, Rhinorrhoea — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Sore throat, cough, aches, stuffy/runny nose, ear pain, headacheMedDRA releases: 2024-11 · check-in free text available
-
2022-01-28
Dose 3 — Moderna
- 2022-07-29
-
2023-01-30
Survey response — 12 months, dose 3MedDRA: Cough, Diarrhoea, Influenza like illness, Pain, Pyrexia, Sinus congestion, Sneezing — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-06-09 | Moderna | |
| 2 | 2021-07-07 | Moderna | No |
| 3 | 2022-01-28 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-08-18 | Unsuccessful |
Free text
Release 9 — day 7, dose 1
Systemic reaction (other): Sore throat
Release 9 — day 42, dose 2
Symptoms: Cough, stuffy nose, sinus pressure
Release 10 — 6 months, dose 2
Symptoms: Sore throat, cough, aches, stuffy/runny nose, ear pain, headache
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 |
|---|---|---|---|---|
| SD | Cough | ✓ | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Ear pain | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Influenza like illness | · | · | ✓ |
| SD | Nasal congestion | ✓ | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Paranasal sinus discomfort | ✓ | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Sinus congestion | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release