6GJ-74270-34340
5 vaccinations
3 coded responses
50 check-ins
3 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 337 / FL
- Registered
- 2021-03-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-03
Dose 1 — Moderna
-
2021-03-04
Registered in v-safe
-
2021-03-04
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-03-05
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-18
- 2021-03-25
-
2021-03-31
Dose 2 — Moderna
- 2021-03-31
- 2021-04-01
- 2021-04-02
- 2021-04-03
-
2021-04-05
Survey response — days 1–6 daily, dose 2MedDRA: Erythema, Injection site bruising, Injection site haemorrhage, Pruritus, Wrong technique in product usage process — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: When I received the shot the pharmacist said she thought she hit a fibrous part of the muscle. It bled more than usual and developed a bruise which has decipated. I woke up this morning with a red line on the back of my thigh. It was itchy and I put hand lotion on it and the itchiness subsided. The red line looks like it has decreased since this morning. Because it's on the back of my thigh, I can only see it in a hand mirror so it's hard to tell how rash like it appears. It is a straight line of redness and not a mark that's spread out.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-06
- 2021-04-07
- 2021-04-14
- 2021-04-22
- 2021-04-28
- 2021-05-05
- 2021-05-12
-
2021-06-30
Survey response — 3 months, dose 2MedDRA: Office visit, Pollakiuria — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Further problems with urinary frequency. · Healthcare visit (other): Cystoscopy at uroligist office.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-30
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-07-06
Call successfulParticipant prefers to complete VAERS report online
- 2021-09-30
-
2021-10-27
Dose 3 — Moderna
- 2021-10-29
- 2021-10-30
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2022-01-26
-
2022-04-15
Dose 4 — Moderna
- 2022-04-19
- 2022-04-20
- 2022-04-21
- 2022-04-22
- 2022-04-29
- 2022-05-07
-
2022-05-13
Survey response — day 28, dose 4MedDRA: Injection site pain, Pain — Feeling: GoodFree text: Muscle in arm where I received vaccination continues to hurt when I stretch my arm in certain positions.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-20
- 2022-05-27
- 2022-07-15
-
2022-09-21
Dose 5 — Moderna
- 2022-10-12
- 2022-10-19
- 2022-10-26
- 2022-11-02
- 2022-12-21
- 2023-03-22
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-03 | Moderna | |
| 2 | 2021-03-31 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
| 5 | 2022-09-21 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): When I received the shot the pharmacist said she thought she hit a fibrous part of the muscle. It bled more than usual and developed a bruise which has decipated. I woke up this morning with a red line on the back of my thigh. It was itchy and I put hand lotion on it and the itchiness subsided. The red line looks like it has decreased since this morning. Because it's on the back of my thigh, I can only see it in a hand mirror so it's hard to tell how rash like it appears. It is a straight line of redness and not a mark that's spread out.
Release 9 — 3 months, dose 2
Symptoms: Further problems with urinary frequency.
Healthcare visit (other): Cystoscopy at uroligist office.
Release 11 — day 28, dose 4
Symptoms: Muscle in arm where I received vaccination continues to hurt when I stretch my arm in certain positions.
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 | Injection site pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pollakiuria | ✓ | ✓ | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Injection site bruising | ✓ | ✓ | ✓ |
| SRO | Injection site haemorrhage | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Wrong technique in product usage process | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release