6QA-13498-85096
4 vaccinations
11 coded responses
48 check-ins
11 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 952 / CA
- Registered
- 2021-03-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-02
Dose 1 — Moderna
-
2021-03-03
Registered in v-safe
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2021-03-03
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-16
- 2021-03-23
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2021-03-30
Dose 2 — Moderna
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2021-03-30
Survey response — day 0, dose 2MedDRA: Eye pruritus — Feeling: Good · Site: Pain, SwellingFree text: Itchy eyes, just like you get at the start of a cold of flu.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-31
Survey response — days 1–6 daily, dose 2MedDRA: Eye pruritus, Superficial injury of eye — Feeling: Good · Site: Pain · Fever · HeadacheFree text: Scratchy eyes continue, mild symptoms.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-01
Survey response — days 1–6 daily, dose 2MedDRA: Eye pruritus, Nasal congestion, Pain — Feeling: Good · Site: PainFree text: Very mild pain, eyes still a little itchy, stuffy. Otherwise fine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-02
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2021-04-03
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Pre-existing disease — Feeling: Good · Joint painsFree text: Joint pain might be from Nexlizet also, which MD prescribed recently...MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-04
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2021-04-05
Survey response — days 1–6 daily, dose 2MedDRA: Abdominal pain upper — Feeling: Good · Abdominal painFree text: While I did have stomach pain, I am quite sure it was due to old scalloped potatoes, not the shot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-06
- 2021-04-13
- 2021-04-20
- 2021-04-27
- 2021-05-05
- 2021-05-11
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2021-07-01
Survey response — 3 months, dose 2MedDRA: Nasal congestion, Rhinorrhoea — Feeling: GoodFree text: A little more nasal congestion, drainage. Assume it is mostly allergy related. Attended a citizenship swearing in ceremony in Roseville CA 6/29 - did not wear mask. Now thinking I should have with Delta+ variant? Will watch.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-09-28
-
2021-10-27
Dose 3 — Moderna
- 2021-10-27
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Chills, Night sweats — Feeling: Good · Site: Pain, Swelling · Fever · Chills, Headache, Joint painsFree text: Only chills with sweats last night. None during the day.MedDRA releases: 2024-11 · check-in free text available
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2021-10-29
Survey response — days 1–6 daily, dose 3MedDRA: Formication, Pruritus, Vaccine positive rechallenge — Feeling: GoodFree text: Odd kinda itchy, creepy crawly sensation on my arms as I went to bed last night. Feeling passed during the night and hasn't returned. Recalled this happened during the second dose also, it has not happened at any other time.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-09
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2022-01-28
Survey response — 3 months, dose 3MedDRA: Food poisoning, Gastroenteritis viral, Influenza like illness, Nasopharyngitis, Pyrexia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Cold/flu-like conditions before Christmas, no sore throat or cough. Food poisoning/stomach flu early January. Fever took 6 days to go away. Listeria?MedDRA releases: 2024-11 · check-in free text available
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2022-03-31
Dose 4 — Moderna
- 2022-04-06
- 2022-04-07
- 2022-04-16
- 2022-04-21
- 2022-04-29
- 2022-05-07
- 2022-05-12
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2022-06-30
Survey response — 3 months, dose 4MedDRA: Arthralgia, Body temperature increased, Cough, Eye irritation, Nasal congestion, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Tested positive for Covid. Fever <100F, cough, nasal and chest congestion, sore throat, runny nose, scratchy eyes. Sore joints. Symptoms for two weeks, positive for 12 days. Now testing negative. Still have nasal and chest congestion. Ok breathing.MedDRA releases: 2024-11 · check-in free text available
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2022-10-01
Survey response — 6 months, dose 4MedDRA: COVID-19, Condition aggravated, Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: After I contracted Covid (May/June), my Hailey-Hailey jumped from my armpit to my groin. Being treated by dermatologist now. · Healthcare visit (other): In dermo office.MedDRA releases: 2024-11 · check-in free text available
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2022-10-01
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
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2022-10-05
Call successfulParticipant prefers to complete VAERS report online
- 2023-03-31
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-02 | Moderna | |
| 2 | 2021-03-30 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
| 4 | 2022-03-31 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 6 — day 0, dose 2
Systemic reaction (other): Itchy eyes, just like you get at the start of a cold of flu.
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Scratchy eyes continue, mild symptoms.
Systemic reaction (other): Very mild pain, eyes still a little itchy, stuffy. Otherwise fine.
Systemic reaction (other): Joint pain might be from Nexlizet also, which MD prescribed recently...
Systemic reaction (other): While I did have stomach pain, I am quite sure it was due to old scalloped potatoes, not the shot.
Release 9 — 3 months, dose 2
Symptoms: A little more nasal congestion, drainage. Assume it is mostly allergy related. Attended a citizenship swearing in ceremony in Roseville CA 6/29 - did not wear mask. Now thinking I should have with Delta+ variant? Will watch.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Only chills with sweats last night. None during the day.
Systemic reaction (other): Odd kinda itchy, creepy crawly sensation on my arms as I went to bed last night. Feeling passed during the night and hasn't returned. Recalled this happened during the second dose also, it has not happened at any other time.
Release 11 — 3 months, dose 3
Symptoms: Cold/flu-like conditions before Christmas, no sore throat or cough. Food poisoning/stomach flu early January. Fever took 6 days to go away. Listeria?
Release 12 — 3 months, dose 4
Symptoms: Tested positive for Covid. Fever <100F, cough, nasal and chest congestion, sore throat, runny nose, scratchy eyes. Sore joints. Symptoms for two weeks, positive for 12 days. Now testing negative. Still have nasal and chest congestion. Ok breathing. cut off by CDC
Release 12 — 6 months, dose 4
Symptoms: After I contracted Covid (May/June), my Hailey-Hailey jumped from my armpit to my groin. Being treated by dermatologist now.
Healthcare visit (other): In dermo office.
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 | Body temperature increased | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Eye irritation | · | · | ✓ |
| SD | Food poisoning | · | · | ✓ |
| SD | Gastroenteritis viral | · | · | ✓ |
| SD | Influenza like illness | · | · | ✓ |
| SD | Nasal congestion | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Abdominal pain upper | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Eye pruritus | ✓ | ✓ | ✓ |
| SRO | Formication | · | · | ✓ |
| SRO | Nasal congestion | ✓ | ✓ | ✓ |
| SRO | Night sweats | · | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Pruritus | · | · | ✓ |
| SRO | Superficial injury of eye | ✓ | ✓ | ○ |
| SRO | Vaccine positive rechallenge | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release