68H-62927-16234
4 vaccinations
4 coded responses
37 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 46-50
- ZIP prefix
- 833 / ID
- Registered
- 2020-12-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-23
Registered in v-safe
-
2020-12-23
Dose 1 — Moderna
- 2020-12-23
- 2020-12-26
-
2020-12-27
Survey response — days 1–6 daily, dose 1MedDRA: Chills — Feeling: Good · Site: Pain · ChillsFree text: I have not felt chills today. I have been unable to report through this system yet that I experienced chills for two hours starting about two hours after the vaccine was administered on the first day. I filled out that day‘s farm before the symptoms and did not see another form for several days.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2020-12-29
- 2020-12-30
- 2021-01-06
- 2021-01-15
-
2021-01-20
Dose 2 — Moderna
-
2021-01-22
Survey response — days 1–6 daily, dose 2MedDRA: Headache — Feeling: Good · Site: Pain, Swelling · Chills, Muscle or body achesFree text: Mild headacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-04-23
- 2021-07-22
-
2021-10-18
Dose 3 — Moderna
-
2021-10-23
Survey response — days 1–6 daily, dose 3MedDRA: Fatigue, Injection site pain, Myalgia — Feeling: GoodFree text: Today is day five after my vaccination date . On day one through day three I had pain at the site. One and two pain at the site and myalgia. On day two I had significant fatigue with myalgias.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-24
- 2021-10-27
- 2021-11-01
- 2021-11-08
- 2021-11-15
- 2021-11-24
- 2021-11-29
- 2022-01-17
-
2022-04-13
Dose 4 — Moderna
- 2022-04-22
-
2022-04-29
Survey response — day 14, dose 4MedDRA: Chondrocalcinosis, Unevaluable event — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: New onset pseudo gout on 4/27/2022 · Healthcare visit (other): ArthrosentesisMedDRA releases: 2024-11 · check-in free text available
-
2022-04-29
Report sent to call center — day 14, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-05-03
Call successfulParticipant prefers to complete VAERS report online
- 2022-05-06
- 2022-05-13
- 2022-05-18
- 2022-05-25
- 2022-10-12
- 2023-04-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-23 | Moderna | |
| 2 | 2021-01-20 | Moderna | |
| 3 | 2021-10-18 | Moderna | No |
| 4 | 2022-04-13 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): I have not felt chills today. I have been unable to report through this system yet that I experienced chills for two hours starting about two hours after the vaccine was administered on the first day. I filled out that day‘s farm before the symptoms and did not see another form for several days.
Release 2 — days 1–6 daily, dose 2
Systemic reaction (other): Mild headache
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Today is day five after my vaccination date . On day one through day three I had pain at the site. One and two pain at the site and myalgia. On day two I had significant fatigue with myalgias.
Release 11 — day 14, dose 4
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 | Chondrocalcinosis | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Myalgia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release