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6VZ-17713-15377

4 vaccinations 8 coded responses 45 check-ins 8 free-text entries 3 call cases
Sex
Male
Age at first dose
66+
ZIP prefix
453 / OH
Registered
2021-01-26
Relationship
Self
Race
White
Ethnicity
N/A

Timeline

  1. 2021-01-21
    Dose 1 — Moderna
  2. 2021-01-26
    Registered in v-safe
  3. 2021-01-26
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness
    Adult check-in
  4. 2021-01-27
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  5. 2021-01-28
    Health check-in — day 7, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  6. 2021-02-04
    Survey response — day 14, dose 1
    MedDRA: Pain in extremity — Feeling: Good
    Free text: The arm that got the injection was sore for the last week. Much better now
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-02-11
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  8. 2021-02-19
    Dose 2 — Moderna
  9. 2021-02-20
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Fatigue or tiredness
    Adult check-in
  10. 2021-02-21
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · None
    Adult check-in
  11. 2021-02-22
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · Fatigue or tiredness
    Adult check-in
  12. 2021-02-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Itching · None
    Adult check-in
  13. 2021-02-24
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-02-25
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-02-26
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-03-05
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-03-12
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-03-20
    Survey response — day 28, dose 2
    MedDRA: Dizziness, Headache — Feeling: Fair
    Free text: Headache and lightheaded. Tired
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-03-26
    Survey response — day 35, dose 2
    MedDRA: Dizziness, Inflammation, Sinus disorder — Feeling: Fair
    Free text: Lightheaded. Had egg and ct scan of head. Swollen sinus
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  20. 2021-04-02
    Survey response — day 42, dose 2
    MedDRA: Arthropathy, Spinal disorder — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Needed ctscan of head and ekg. Bad hip and spine
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-04-02
    Report sent to call center — day 42, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  22. 2021-05-21
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-06-11
    Call successful
    Not applicable - Accidental Reporting
  24. 2021-08-20
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-10-29
    Dose 3 — Moderna
  26. 2021-10-29
    Health check-in — day 0, dose 3
    Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  27. 2021-10-30
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · Site: Itching · Muscle or body aches, Fatigue or tiredness
    Adult check-in
  28. 2021-10-31
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  29. 2021-11-02
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  30. 2021-11-03
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  31. 2021-11-04
    Health check-in — days 1–6 daily, dose 3
    Feeling: Good · None
    Adult check-in
  32. 2021-11-05
    Health check-in — day 7, dose 3
    Feeling: Good · None
    Adult check-in
  33. 2021-11-12
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  34. 2021-11-19
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  35. 2021-11-26
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  36. 2021-12-03
    Survey response — day 35, dose 3
    MedDRA: Dizziness — Feeling: Fair
    Free text: Lightheaded. Same as I had I March They thought it was sinus problems
    MedDRA releases: 2024-11 · check-in free text available
  37. 2021-12-10
    Health check-in — day 42, dose 3
    Feeling: Good
    Adult check-in
  38. 2022-01-28
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  39. 2022-05-01
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  40. 2022-05-26
    Dose 4 — Moderna
  41. 2022-05-30
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · Headache, Fatigue or tiredness
    Adult check-in
  42. 2022-05-31
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  43. 2022-06-01
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in
  44. 2022-06-04
    Health check-in — day 7, dose 4
    Feeling: Good · None
    Adult check-in
  45. 2022-06-09
    Survey response — day 14, dose 4
    MedDRA: Ear pain, Oropharyngeal pain, Unevaluable event — Feeling: Fair
    Free text: Ear or throat pain off and on no graver only about 96.5
    MedDRA releases: 2024-11 · check-in free text available
  46. 2022-06-16
    Survey response — day 21, dose 4
    MedDRA: Office visit, Upper respiratory tract infection — Feeling: Poor · Get care from a doctor or other healthcare professional
    Free text: Symptoms: Upperresatory infection since Monday night · Healthcare visit (other): Family doctor
    MedDRA releases: 2024-11 · check-in free text available
  47. 2022-06-16
    Report sent to call center — day 21, dose 4
    Get care from a doctor or other healthcare professional
    1 call case(s)
  48. 2022-06-17
  49. 2022-06-17
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  50. 2022-06-23
    Survey response — day 28, dose 4
    MedDRA: Upper respiratory tract infection — 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
    Free text: Upper respiratory infection
    MedDRA releases: 2024-11 · check-in free text available
  51. 2022-06-23
    Report sent to call center — day 28, dose 4
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  52. 2022-06-24
    Call successful
    Does not wish to fill out VAERS report
  53. 2022-06-30
    Health check-in — day 35, dose 4
    Feeling: Good
    Adult check-in
  54. 2022-07-08
    Health check-in — day 42, dose 4
    Feeling: Fair
    Adult check-in
  55. 2022-08-25
    Health check-in — 3 months, dose 4
    Feeling: Good
    Adult check-in
  56. 2022-11-24
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  57. 2023-05-26
    Health check-in — 12 months, dose 4
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-21Moderna
22021-02-19Moderna
32021-10-29Moderna No
42022-05-26Moderna No

Call center

3 call center cases

3 successful

See the call center timeline

Free text

Release 3 — day 14, dose 1

2021-02-04

Symptoms: The arm that got the injection was sore for the last week. Much better now

Release 6 — day 28, dose 2

2021-03-20

Symptoms: Headache and lightheaded. Tired

Release 6 — day 35, dose 2

2021-03-26

Symptoms: Lightheaded. Had egg and ct scan of head. Swollen sinus

Release 6 — day 42, dose 2

2021-04-02

Symptoms: Needed ctscan of head and ekg. Bad hip and spine

Release 10 — day 35, dose 3

2021-12-03

Symptoms: Lightheaded. Same as I had I March They thought it was sinus problems

Release 12 — day 14, dose 4

2022-06-09

Symptoms: Ear or throat pain off and on no graver only about 96.5

Release 12 — day 21, dose 4

2022-06-16

Symptoms: Upperresatory infection since Monday night
Healthcare visit (other): Family doctor

Release 12 — day 28, dose 4

2022-06-23

Symptoms: Upper respiratory infection

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
HCVOOffice visit · · ✓
SDArthropathy ✓ ✓ ✓
SDDizziness ✓ ✓ ✓
SDEar pain · · ✓
SDHeadache ✓ ✓ ✓
SDInflammation ✓ ✓ ✓
SDOropharyngeal pain · · ✓
SDPain in extremity ✓ ✓ ✓
SDSinus disorder ✓ ✓ ✓
SDSpinal disorder ✓ ✓ ✓
SDUnevaluable event · · ✓
SDUpper respiratory tract infection · · ✓

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

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