6UN-20647-75607
5 vaccinations
8 coded responses
57 check-ins
7 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 980 / WA
- Registered
- 2021-05-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-05-01
Registered in v-safe
-
2021-05-01
Dose 1 — Moderna
- 2021-05-01
-
2021-05-02
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tirednessAdult check-in
- 2021-05-03
- 2021-05-04
- 2021-05-05
- 2021-05-06
- 2021-05-07
- 2021-05-08
- 2021-05-15
- 2021-05-23
-
2021-05-29
Dose 2 — Moderna
- 2021-05-29
-
2021-05-30
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
- 2021-05-31
- 2021-06-01
- 2021-06-02
- 2021-06-03
- 2021-06-04
- 2021-06-05
- 2021-06-12
- 2021-06-19
- 2021-06-28
- 2021-07-03
-
2021-07-11
Survey response — day 42, dose 2MedDRA: Pain in extremity, Thrombosis — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Leg pain- turned out to be clot in left calf; have family history of blood clotsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-07-11
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-07-20
Call successfulDoes not wish to fill out VAERS report
- 2021-08-28
- 2021-11-27
-
2021-12-06
Dose 3 — Moderna
- 2021-12-08
- 2021-12-10
- 2021-12-11
- 2021-12-12
-
2021-12-13
Survey response — day 7, dose 3MedDRA: Eye pruritus, Throat irritation — Feeling: GoodFree text: Scratchy eyes and throatMedDRA releases: 2024-11 · check-in free text available
-
2021-12-20
Survey response — day 14, dose 3MedDRA: Respiratory tract congestion — Feeling: FairFree text: CongestionMedDRA releases: 2024-11 · check-in free text available
- 2021-12-27
- 2022-01-03
- 2022-01-10
- 2022-01-18
- 2022-03-07
-
2022-04-25
Dose 4 — Pfizer-BioNTech
- 2022-04-26
-
2022-04-27
Survey response — days 1–6 daily, dose 4MedDRA: Night sweats — Feeling: GoodFree text: I had night sweats last night, but no feverMedDRA releases: 2024-11 · check-in free text available
- 2022-04-28
- 2022-04-29
- 2022-04-30
- 2022-05-01
- 2022-05-02
- 2022-05-09
- 2022-05-16
-
2022-05-23
Survey response — day 28, dose 4MedDRA: Eye pruritus, Headache, Respiratory tract congestion — Feeling: FairFree text: Itchy eyes, mild headache, congestionMedDRA releases: 2024-11 · check-in free text available
-
2022-06-01
Survey response — day 35, dose 4MedDRA: Pre-existing disease, Respiratory tract congestion, Sinusitis — Feeling: FairFree text: I have congestion which I think is a secondary nasal infection from allergiesMedDRA releases: 2024-11 · check-in free text available
- 2022-06-06
-
2022-07-25
Survey response — 3 months, dose 4MedDRA: Exercise tolerance decreased, Heart rate increased, Pre-existing disease, Respiratory rate increased — Feeling: Good · Be unable to work or attend schoolFree text: I had symptoms of exercise intolerance - increases breathing and heart rate at lower exertion than typical. Also found peripheral blot clots. (I had DVT with PE last year)MedDRA releases: 2024-11 · check-in free text available
-
2022-10-14
Dose 5 — Pfizer-BioNTechCo-administered: Flu
- 2022-10-24
- 2022-10-24
- 2022-10-28
- 2022-11-04
- 2022-11-13
- 2022-11-18
- 2022-11-25
-
2023-04-14
Survey response — 6 months, dose 5MedDRA: Cough, Disturbance in attention, Fatigue, Headache, Sinus congestion — Feeling: Good · Be unable to work or attend schoolMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-05-01 | Moderna | |
| 2 | 2021-05-29 | Moderna | |
| 3 | 2021-12-06 | Moderna | No |
| 4 | 2022-04-25 | Pfizer-BioNTech | No |
| 5 | 2022-10-14 | Pfizer-BioNTech | Flu |
Call center
1 call center case
1 successful
Free text
Release 9 — day 42, dose 2
Symptoms: Leg pain- turned out to be clot in left calf; have family history of blood clots
Release 10 — day 7, dose 3
Systemic reaction (other): Scratchy eyes and throat
Release 10 — day 14, dose 3
Symptoms: Congestion
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): I had night sweats last night, but no fever
Release 11 — day 28, dose 4
Symptoms: Itchy eyes, mild headache, congestion
Release 11 — day 35, dose 4
Symptoms: I have congestion which I think is a secondary nasal infection from allergies
Release 12 — 3 months, dose 4
Symptoms: I had symptoms of exercise intolerance - increases breathing and heart rate at lower exertion than typical. Also found peripheral blot clots. (I had DVT with PE last year)
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 |
|---|---|---|---|---|
| SD | Cough | · | · | ✓ |
| SD | Disturbance in attention | · | · | ✓ |
| SD | Exercise tolerance decreased | · | · | ✓ |
| SD | Eye pruritus | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Heart rate increased | · | · | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Respiratory rate increased | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Sinus congestion | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SD | Thrombosis | ✓ | ✓ | ✓ |
| SRO | Eye pruritus | · | · | ✓ |
| SRO | Night sweats | · | · | ✓ |
| SRO | Throat irritation | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release