66S-10226-63354
3 vaccinations
10 coded responses
28 check-ins
11 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 130 / NY
- Registered
- 2021-03-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-09
Registered in v-safe
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2021-03-09
Dose 1 — Moderna
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2021-03-09
Survey response — day 0, dose 1MedDRA: Injection site pain — Feeling: Good · Site: PainFree text: Pain during injection but not afterMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-10
- 2021-03-11
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2021-03-12
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue — Feeling: Good · Fatigue or tirednessFree text: normal" tiredness from prescriptionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-13
- 2021-03-14
- 2021-03-15
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2021-03-16
Survey response — day 7, dose 1MedDRA: Sinus headache — Feeling: Good · HeadacheFree text: Feels more like sinus headacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-23
- 2021-03-30
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2021-04-06
Dose 2 — Moderna
- 2021-04-06
- 2021-04-07
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2021-04-08
Survey response — days 1–6 daily, dose 2MedDRA: Condition aggravated, Headache, Injection site pain, Pre-existing disease, Respiratory tract congestion — Feeling: Good · Joint pains, Muscle or body achesFree text: Injection site did not hurt until hours later on shot day. Felt congested (usually am due to bronchitis) & mild headache. All this suddenly stopped last night, felt very good.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-09
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2021-04-10
Survey response — days 1–6 daily, dose 2MedDRA: Arthritis, Back pain, Pre-existing disease, Sinus disorder — Feeling: Good · Joint painsFree text: Back to usual sinus, arthritis lower back pain.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-11
- 2021-04-12
- 2021-04-13
- 2021-04-20
- 2021-04-27
- 2021-05-04
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2021-05-11
Survey response — day 35, dose 2MedDRA: Arthralgia, Pain in extremity — Feeling: FairFree text: Since Easter, left knee hurts on & off. Could be injury. I sleep on left side, injection site, which hurts sometimes, going down arm, elbow which feels loose.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-18
Survey response — day 42, dose 2MedDRA: Arthralgia, Office visit, Sensitive skin, Vitreous floaters — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Still have sore knee, sensitive on side, as well as elbow. At 74, to be expected. Floaters in left eye now too · Healthcare visit (other): Doctor's officeMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-18
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-07-06
Survey response — 3 months, dose 2MedDRA: Mitral valve repair, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Operation to repair mitral valveMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-10-06
Survey response — 6 months, dose 2MedDRA: Arthralgia, Bronchitis, Mitral valve repair, Pain in extremity — Feeling: FairFree text: Had mitral valve repair June, so many changes. Cold wet weather not good for bronchitis. Some joint pain still, sometimes sore calf probably due to medsMedDRA releases: 2024-11 · check-in free text available
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2021-12-23
Dose 3 — Moderna
- 2022-04-07
- 2022-04-18
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2022-04-22
Call successfulParticipant prefers to complete VAERS report online
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2022-06-25
Survey response — 6 months, dose 3MedDRA: Arthralgia, Gait disturbance, Pain in extremity, Post procedural complication, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Mitral valve repair last June 30, some problems from that & warfarin are complicating reporting on vax effects. Right calf sore on & off making walking difficult. Goes up to hip After appts July might get off warfarin & see if that cures leg problemMedDRA releases: 2024-11 · check-in free text available
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2022-12-24
Health check-in — 12 months, dose 3Feeling: Fair · Be unable to do your normal daily activitiesFree text: Pain in right leg increased to point of not being able to stand up occasionally. Statin was changed, just nuisance ache now, which had been diminishing prior. Tests found no problems.Adult check-in · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-09 | Moderna | |
| 2 | 2021-04-06 | Moderna | |
| 3 | 2021-12-23 | Moderna | No |
Call center
1 call center case
1 successful
1 wait over 3 months for a first call
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): Pain during injection but not after
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): normal" tiredness from prescription
Release 5 — day 7, dose 1
Systemic reaction (other): Feels more like sinus headache
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Injection site did not hurt until hours later on shot day. Felt congested (usually am due to bronchitis) & mild headache. All this suddenly stopped last night, felt very good.
Systemic reaction (other): Back to usual sinus, arthritis lower back pain.
Release 8 — day 35, dose 2
Symptoms: Since Easter, left knee hurts on & off. Could be injury. I sleep on left side, injection site, which hurts sometimes, going down arm, elbow which feels loose.
Release 8 — day 42, dose 2
Symptoms: Still have sore knee, sensitive on side, as well as elbow. At 74, to be expected. Floaters in left eye now too
Healthcare visit (other): Doctor's office
Release 9 — 3 months, dose 2
Symptoms: Operation to repair mitral valve
Release 10 — 6 months, dose 2
Symptoms: Had mitral valve repair June, so many changes. Cold wet weather not good for bronchitis. Some joint pain still, sometimes sore calf probably due to meds
Release 12 — 6 months, dose 3
Symptoms: Mitral valve repair last June 30, some problems from that & warfarin are complicating reporting on vax effects. Right calf sore on & off making walking difficult. Goes up to hip After appts July might get off warfarin & see if that cures leg problem cut off by CDC
Release 12 — 12 months, dose 3
Symptoms: Pain in right leg increased to point of not being able to stand up occasionally. Statin was changed, just nuisance ache now, which had been diminishing prior. Tests found no problems.
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 | Bronchitis | · | · | ✓ |
| SD | Gait disturbance | · | · | ✓ |
| SD | Mitral valve repair | ✓ | ✓ | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Post procedural complication | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Sensitive skin | ✓ | ✓ | ✓ |
| SD | Vitreous floaters | ✓ | ✓ | ✓ |
| SRO | Arthritis | ✓ | ✓ | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
| SRO | Condition aggravated | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Respiratory tract congestion | ✓ | ✓ | ✓ |
| SRO | Sinus disorder | ✓ | ✓ | ✓ |
| SRO | Sinus headache | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release