6R6-27668-98108
4 vaccinations
5 coded responses
39 check-ins
5 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 554 / MN
- Registered
- 2021-02-26
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-25
Dose 1 — Moderna
-
2021-02-26
Registered in v-safe
- 2021-02-26
- 2021-02-27
- 2021-02-28
-
2021-03-01
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Good · HeadacheFree text: Im very concerned that I am vaccinated but my wife isnt. It doesnt make sense to only have half a household vaccinated. My wife is 63 but we operate an essential business delivering PPE to nursing homes, clinics, schools, etc. how can I get her vaccinated? Please assist us.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-11
- 2021-03-18
-
2021-03-25
Dose 2 — Moderna
- 2021-03-25
- 2021-03-26
- 2021-03-27
- 2021-03-28
-
2021-03-29
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: GoodFree text: Is Vault going to provide a wallet size card for people to carry that has our vaccination information on it? I have the record card provided at the vaccination site but it it too large. Needs to be the size of a standard credit card.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-30
- 2021-03-31
- 2021-04-01
- 2021-04-08
- 2021-04-15
- 2021-04-22
- 2021-04-29
- 2021-05-06
- 2021-06-24
-
2021-09-01
Dose 3 — Moderna
- 2021-09-26
-
2021-12-01
Survey response — 3 months, dose 3MedDRA: Office visit, Pre-existing disease, Prostatic specific antigen decreased — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: My prostate cancer has responded well to a new treatment and my PSA is now essentially undetectable. · Healthcare visit (other): Regular oncology visit.MedDRA releases: 2024-11 · check-in free text available
-
2021-12-01
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professional1 call case(s)
-
2021-12-02
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-03-02
-
2022-05-14
Dose 4 — Pfizer-BioNTech
- 2022-05-14
-
2022-05-15
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2022-05-16
- 2022-05-17
- 2022-05-19
- 2022-05-20
- 2022-05-21
- 2022-05-28
- 2022-06-04
- 2022-06-11
- 2022-06-18
-
2022-08-13
Survey response — 3 months, dose 4MedDRA: Cough, Headache, Oropharyngeal pain, Pain, Pre-existing disease, Pyrexia, SARS-CoV-2 test positive — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Tested positive this morning for covid. Sore throat, bad cough, 99-100.5 fever, body aches and headache. I'm going to a " test and treat" clinic at 3:40 to hopefully get anti viral meds because I am also being treated for cancer.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-12
Survey response — 6 months, dose 4MedDRA: COVID-19, Medical counselling, Odynophagia, Pain, Pyrexia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Severe covid Lasted about a week. Fever, pain to swallow, body aches. · Healthcare visit (other): CVS minute Clinic.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-12
Report sent to call center — 6 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-11-14
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-25 | Moderna | |
| 2 | 2021-03-25 | Moderna | |
| 3 | 2021-09-01 | Moderna | No |
| 4 | 2022-05-14 | Pfizer-BioNTech | No |
Call center
2 call center cases
2 successful
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Im very concerned that I am vaccinated but my wife isnt. It doesnt make sense to only have half a household vaccinated. My wife is 63 but we operate an essential business delivering PPE to nursing homes, clinics, schools, etc. how can I get her vaccinated? Please assist us.
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Is Vault going to provide a wallet size card for people to carry that has our vaccination information on it? I have the record card provided at the vaccination site but it it too large. Needs to be the size of a standard credit card.
Release 10 — 3 months, dose 3
Symptoms: My prostate cancer has responded well to a new treatment and my PSA is now essentially undetectable.
Healthcare visit (other): Regular oncology visit.
Release 12 — 3 months, dose 4
Symptoms: Tested positive this morning for covid. Sore throat, bad cough, 99-100.5 fever, body aches and headache. I'm going to a " test and treat" clinic at 3:40 to hopefully get anti viral meds because I am also being treated for cancer.
Release 12 — 6 months, dose 4
Symptoms: Severe covid Lasted about a week. Fever, pain to swallow, body aches.
Healthcare visit (other): CVS minute Clinic.
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 | Medical counselling | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Odynophagia | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Prostatic specific antigen decreased | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release