647-28430-53884
4 vaccinations
5 coded responses
27 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 900 / CA
- Registered
- 2021-02-26
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Registered dependents
VL5-21223-03917
Adult relative or friend · Male · 2022-04-07
Timeline
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2021-01-21
Dose 1 — Moderna
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2021-02-16
Dose 2 — Moderna
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2021-02-26
Registered in v-safe
- 2021-02-26
- 2021-03-04
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-05-18
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2021-08-17
Survey response — 6 months, dose 2MedDRA: Abdominal pain upper, Discomfort, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Never has my upper stomach hurt in all my life, until last 2-mo. MD. ordered CT/PET last Week; 8/14 he reported tests showed no issue for concern. Still, I feel the same discomfort; no food, drink or lifestyle is a contributor. It concerns me! · Healthcare visit (other): CT Scan and PETMedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-17
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-10-07
Dose 3 — Moderna
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2021-10-09
Survey response — days 1–6 daily, dose 3MedDRA: Chest discomfort, Electric shock sensation — Feeling: Poor · Headache, Muscle or body aches · Be unable to do your normal daily activitiesFree text: Chest sensations like electric currentMedDRA releases: 2024-11 · check-in free text available
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2021-10-10
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-10-12
Survey response — days 1–6 daily, dose 3MedDRA: Feeling abnormal, Malaise, Office visit, Paraesthesia — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): Still NOT "my usual SELF"!! not feeling as well as on 10/6/21 day BEFORE Moderna Shot on 10/7/21 at or near 4 p.m. Chest/heart-area tingling sensation!. · Healthcare visit (other): A pre-scheduled visit to Internist. I informed Doc of my feelings since 10/6 to today!MedDRA releases: 2024-11 · check-in free text available
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2021-10-12
Report sent to call center — days 1–6 daily, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-10-13
Survey response — days 1–6 daily, dose 3MedDRA: Flat affect, Malaise — Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Malaise. Flat.MedDRA releases: 2024-11 · check-in free text available
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2021-10-13
Call successfulReported to VAERS voluntarily prior to GDIT contact
- 2021-10-14
- 2021-10-21
- 2021-10-28
- 2021-11-04
- 2021-11-11
- 2021-11-18
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2022-01-06
Survey response — 3 months, dose 3MedDRA: Rhinorrhoea — Feeling: GoodFree text: Slight runny nose, off and on, since 12/26/21 to now 1/6/22.MedDRA releases: 2024-11 · check-in free text available
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2022-04-07
Dose 4 — Moderna
- 2022-04-07
- 2022-04-07
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2022-04-10
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Itching · Fatigue or tirednessAdult check-in
- 2022-04-12
- 2022-04-13
- 2022-04-14
- 2022-04-21
- 2022-04-28
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-21 | Moderna | |
| 2 | 2021-02-16 | Moderna | |
| 3 | 2021-10-07 | Moderna | No |
| 4 | 2022-04-07 | Moderna | No |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 2
Free text
Release 9 — 6 months, dose 2
Symptoms: Never has my upper stomach hurt in all my life, until last 2-mo. MD. ordered CT/PET last Week; 8/14 he reported tests showed no issue for concern. Still, I feel the same discomfort; no food, drink or lifestyle is a contributor. It concerns me!
Healthcare visit (other): CT Scan and PET
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Chest sensations like electric current
Systemic reaction (other): Still NOT "my usual SELF"!! not feeling as well as on 10/6/21 day BEFORE Moderna Shot on 10/7/21 at or near 4 p.m. Chest/heart-area tingling sensation!.
Healthcare visit (other): A pre-scheduled visit to Internist. I informed Doc of my feelings since 10/6 to today!
Systemic reaction (other): Malaise. Flat.
Release 10 — 3 months, dose 3
Symptoms: Slight runny nose, off and on, since 12/26/21 to now 1/6/22.
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 | · | · | ✓ |
| HCVO | Unevaluable event | ✓ | · | ✓ |
| SD | Abdominal pain upper | ✓ | · | ✓ |
| SD | Discomfort | ✓ | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SRO | Chest discomfort | · | · | ✓ |
| SRO | Electric shock sensation | · | · | ✓ |
| SRO | Feeling abnormal | · | · | ✓ |
| SRO | Flat affect | · | · | ✓ |
| SRO | Malaise | · | · | ✓ |
| SRO | Paraesthesia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release