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6TB-29192-94878

2 vaccinations 5 coded responses 14 check-ins 5 free-text entries 2 call cases
Sex
Female
Age at first dose
0-4
ZIP prefix
117 / NY
Registered
2022-06-28
Relationship
Child or adolescent in my care
Guardian
P77-23968-86428
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2022-06-28
    Registered in v-safe
  2. 2022-07-02
    Dose 1 — Moderna
  3. 2022-07-06
    Survey response — days 1–6 daily, dose 1, under 3
    MedDRA: Injection site erythema, Injection site induration, Injection site swelling, Pyrexia — Feeling: Good · Site: Pain, Redness, Swelling/hardness · Fever
    Free text: Had fever until ~48hr after vaccine, tmax 101.7 rectal 24hr after vaccine. Injection site had 4cm firm erythematous swelling for about 72hr, is still mildly erythematous and swelling is no longer firm but is still present.
    MedDRA releases: 2024-11 · check-in free text available
  4. 2022-07-11
    Health check-in — day 7, dose 1, under 3
    Feeling: Good · Fever · Rash, not including the immediate area around the injection site
    Under 3 check-in
  5. 2022-07-16
    Health check-in — day 14, dose 1, under 3
    Feeling: Good
    Under 3 check-in
  6. 2022-07-23
    Survey response — day 21, dose 1, under 3
    MedDRA: Pyrexia, Rhinorrhoea, Somnolence — Feeling: Good
    Free text: Runny nose, tactile fever, sleepy
    MedDRA releases: 2024-11 · check-in free text available
  7. 2022-07-30
    Dose 2 — Moderna
  8. 2022-07-30
    Health check-in — day 0, dose 2, under 3
    Feeling: Fair · Sleepiness, Irritability/crying
    Under 3 check-in
  9. 2022-07-31
    Health check-in — days 1–6 daily, dose 2, under 3
    Feeling: Good · Site: Swelling/hardness · Sleepiness, Irritability/crying
    Under 3 check-in
  10. 2022-08-01
    Health check-in — days 1–6 daily, dose 2, under 3
    Feeling: Good · Site: Redness, Swelling/hardness · Rash, not including the immediate area around the injection site
    Under 3 check-in
  11. 2022-08-04
    Health check-in — days 1–6 daily, dose 2, under 3
    Feeling: Good · None
    Under 3 check-in
  12. 2022-08-06
    Health check-in — day 7, dose 2, under 3
    Feeling: Good · None
    Under 3 check-in
  13. 2022-08-13
    Survey response — day 14, dose 2, under 3
    MedDRA: Decreased appetite, Pyrexia, Somnolence — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Fever, sleepy, decreased appetite
    MedDRA releases: 2024-11 · check-in free text available
  14. 2022-08-13
    Report sent to call center — day 14, dose 2, under 3
    Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  15. 2022-08-15
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  16. 2022-08-23
    Health check-in — day 21, dose 2, under 3
    Feeling: Good
    Under 3 check-in
  17. 2022-09-06
    Survey response — day 35, dose 2, under 3
    MedDRA: Fatigue, Pyrexia, Vomiting — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Fever, fatigue, vomiting
    MedDRA releases: 2024-11 · check-in free text available
  18. 2022-09-06
    Report sent to call center — day 35, dose 2, under 3
    Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  19. 2022-09-07
  20. 2022-09-07
    Call successful
    Participant prefers to complete VAERS report online
  21. 2022-09-10
    Health check-in — day 42, dose 2, under 3
    Feeling: Good
    Under 3 check-in
  22. 2022-10-29
    Survey response — 3 months, dose 2, under 3
    MedDRA: Coxsackie viral infection, Illness, Viral upper respiratory tract infection — Feeling: Good
    Free text: Had coxsackie and two other viral URIs. Didn't get tested with every illness. Mother was exposed to covid at work, unsure if (b)(6) may have had covid.
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12022-07-02Moderna No
22022-07-30Moderna No

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 12 (Under 3) — days 1–6 daily, dose 1, under 3

2022-07-06

Systemic reaction (other): Had fever until ~48hr after vaccine, tmax 101.7 rectal 24hr after vaccine. Injection site had 4cm firm erythematous swelling for about 72hr, is still mildly erythematous and swelling is no longer firm but is still present.

Release 12 (Under 3) — day 21, dose 1, under 3

2022-07-23

Symptoms: Runny nose, tactile fever, sleepy

Release 12 (Under 3) — day 14, dose 2, under 3

2022-08-13

Symptoms: Fever, sleepy, decreased appetite

Release 12 (Under 3) — day 35, dose 2, under 3

2022-09-06

Symptoms: Fever, fatigue, vomiting

Release 12 (Under 3) — 3 months, dose 2, under 3

2022-10-29

Symptoms: Had coxsackie and two other viral URIs. Didn't get tested with every illness. Mother was exposed to covid at work, unsure if (b)(6) may have had covid.
redacted (b)(6)

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

FieldPreferred term2021-092023-042024-11
SDCoxsackie viral infection · · ✓
SDDecreased appetite · · ✓
SDFatigue · · ✓
SDIllness · · ✓
SDPyrexia · · ✓
SDRhinorrhoea · · ✓
SDSomnolence · · ✓
SDViral upper respiratory tract infection · · ✓
SDVomiting · · ✓
SROInjection site erythema · · ✓
SROInjection site induration · · ✓
SROInjection site swelling · · ✓
SROPyrexia · · ✓

✓ active code · ○ coded but marked inactive · blank = not in that release

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