6VW-29720-63283
3 vaccinations
6 coded responses
40 check-ins
6 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 338 / FL
- Registered
- 2021-01-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-21
Registered in v-safe
-
2021-01-21
Dose 1 — Moderna
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-02-04
- 2021-02-11
- 2021-02-18
-
2021-02-24
Dose 2 — Moderna
-
2021-02-25
Survey response — days 1–6 daily, dose 2MedDRA: Injection site pain, Injection site reaction — Feeling: GoodFree text: slight tenderness of muscle at injection site if it is touched.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-10
- 2021-03-17
- 2021-03-24
- 2021-03-31
- 2021-04-07
- 2021-05-26
- 2021-08-25
-
2021-10-27
Dose 3 — Moderna
-
2021-10-27
Survey response — day 0, dose 3MedDRA: Decreased appetite — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activitiesFree text: loss of appetiteMedDRA releases: 2024-11 · check-in free text available
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-11
-
2021-11-17
Survey response — day 21, dose 3MedDRA: Arthralgia, Back pain, Herpes zoster — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I have had recurring back and shoulder pain, and was diagnosed yesterday with shingles.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-17
Report sent to call center — day 21, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-11-18
-
2021-11-24
Survey response — day 28, dose 3MedDRA: Arthralgia, Back pain, Herpes zoster, Office visit, Rash — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Began having a lot of pain in my left mid-back, which then moved to my left shoulder. This pain was accompanied by a light rash. Doctor said I had shingles and was given an anti-viral. Condition cleared up.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-24
Report sent to call center — day 28, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-12-01
-
2021-12-08
Survey response — day 42, dose 3MedDRA: Herpes zoster, Pain — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Pain from shingles for the 4th time since yhe booster.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-14
- 2022-01-24
-
2022-01-24
Call successfulParticipant prefers to complete VAERS report online
-
2022-01-24
Call successfulParticipant prefers to complete VAERS report online
- 2022-01-26
- 2022-04-27
-
2022-10-27
Survey response — 12 months, dose 3MedDRA: COVID-19, Fatigue, Herpes zoster, Neuralgia, SARS-CoV-2 test positive — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: I had a mild case of Covid--no fever, mainly tiredness, but I did test + on home test. I have also had the same kind deep nerve pain as last Oct. then diagnosed as shingles- 12 times, even after shingles shot. Most times about 2-3 days-last 4 daysMedDRA releases: 2024-11 · check-in free text available
-
2022-10-27
Report sent to call center — 12 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
-
2022-10-28
Call successfulReported to VAERS voluntarily prior to GDIT contact
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-21 | Moderna | |
| 2 | 2021-02-24 | Moderna | |
| 3 | 2021-10-27 | Moderna | No |
Call center
3 call center cases
3 successful
VAERS report filed, before or during a call: 1
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): slight tenderness of muscle at injection site if it is touched.
Release 10 — day 0, dose 3
Systemic reaction (other): loss of appetite
Release 10 — day 21, dose 3
Symptoms: I have had recurring back and shoulder pain, and was diagnosed yesterday with shingles.
Release 10 — day 28, dose 3
Symptoms: Began having a lot of pain in my left mid-back, which then moved to my left shoulder. This pain was accompanied by a light rash. Doctor said I had shingles and was given an anti-viral. Condition cleared up.
Release 10 — day 42, dose 3
Symptoms: Pain from shingles for the 4th time since yhe booster.
Release 12 — 12 months, dose 3
Symptoms: I had a mild case of Covid--no fever, mainly tiredness, but I did test + on home test. I have also had the same kind deep nerve pain as last Oct. then diagnosed as shingles- 12 times, even after shingles shot. Most times about 2-3 days-last 4 days cut off by CDC
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 | Arthralgia | · | · | ✓ |
| SD | Back pain | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Herpes zoster | · | · | ✓ |
| SD | Neuralgia | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Rash | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Decreased appetite | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Injection site reaction | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release