6XF-11089-72053
4 vaccinations
5 coded responses
45 check-ins
5 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 46-50
- ZIP prefix
- 468 / IN
- Registered
- 2021-03-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-07
Dose 1 — Janssen/Johnson & Johnson
-
2021-03-11
Registered in v-safe
- 2021-03-11
- 2021-03-14
-
2021-03-23
Survey response — day 14, dose 1MedDRA: Urticaria — Feeling: GoodFree text: Hives. Im not sure they are from vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-28
- 2021-04-07
- 2021-04-11
- 2021-06-08
- 2021-09-05
-
2021-10-23
Dose 2 — Janssen/Johnson & Johnson
- 2021-10-23
- 2021-10-24
-
2021-10-25
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Chills, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
- 2021-10-27
-
2021-10-28
Health check-in — days 1–6 daily, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2021-10-29
- 2021-10-30
- 2021-11-06
- 2021-11-22
- 2021-11-27
-
2021-12-04
Survey response — day 42, dose 2MedDRA: Cough, Oropharyngeal pain, Respiratory tract congestion, Rhinorrhoea — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Cough, runny nose, congestion, sore throatMedDRA releases: 2024-11 · check-in free text available
-
2021-12-04
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
-
2021-12-07
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-01-25
Survey response — 3 months, dose 2MedDRA: Cough, Fatigue, Lymph node pain, Lymphadenopathy, Muscle tightness, Pain, Rhinorrhoea, Throat irritation, Upper-airway cough syndrome — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Painful and swollen lymph nodes in neck, muscle tightness in neck causing difficulty moving head without pain, scratchy throat, nasal drainage, nasal dripping, alight cough, fatigue, body achesMedDRA releases: 2024-11 · check-in free text available
-
2022-04-01
Dose 3 — Moderna
- 2022-04-01
- 2022-04-02
- 2022-04-03
- 2022-04-05
- 2022-04-06
- 2022-04-07
- 2022-04-08
- 2022-04-16
- 2022-04-23
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-07-01
-
2022-09-29
Dose 4 — ModernaCo-administered: Flu
- 2022-09-30
-
2022-10-01
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Redness, Swelling, Itching · Joint painsAdult check-in
-
2022-10-02
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Redness, Swelling, Itching · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-10-04
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Redness, Itching · NoneAdult check-in
-
2022-10-05
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Redness, Itching · NoneAdult check-in
- 2022-10-08
-
2022-10-15
Survey response — day 14, dose 4MedDRA: Arthritis, Inflammation, Joint range of motion decreased, Mobility decreased — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Sudden Severe onset of right should pain with partial loss of range of motion. Pain and inflammation making it difficult to use arm. Seeking professional help today.MedDRA releases: 2024-11 · check-in free text available
- 2022-10-20
- 2022-10-28
- 2022-11-04
-
2022-12-29
Survey response — 3 months, dose 4MedDRA: Influenza — 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: Influenza AMedDRA releases: 2024-11 · check-in free text available
-
2022-12-29
Report sent to call center — 3 months, dose 4Be 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)
-
2022-12-30
Call successfulParticipant prefers to complete VAERS report online
- 2023-04-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-07 | Janssen/Johnson & Johnson | |
| 2 | 2021-10-23 | Janssen/Johnson & Johnson | No |
| 3 | 2022-04-01 | Moderna | No |
| 4 | 2022-09-29 | Moderna | Flu |
Call center
2 call center cases
2 successful
Free text
Release 6 — day 14, dose 1
Symptoms: Hives. Im not sure they are from vaccine.
Release 10 — day 42, dose 2
Symptoms: Cough, runny nose, congestion, sore throat
Release 11 — 3 months, dose 2
Symptoms: Painful and swollen lymph nodes in neck, muscle tightness in neck causing difficulty moving head without pain, scratchy throat, nasal drainage, nasal dripping, alight cough, fatigue, body aches
Release 12 — day 14, dose 4
Symptoms: Sudden Severe onset of right should pain with partial loss of range of motion. Pain and inflammation making it difficult to use arm. Seeking professional help today.
Release 12 — 3 months, dose 4
Symptoms: Influenza A
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 | Arthritis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Inflammation | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Joint range of motion decreased | · | · | ✓ |
| SD | Lymph node pain | · | · | ✓ |
| SD | Lymphadenopathy | · | · | ✓ |
| SD | Mobility decreased | · | · | ✓ |
| SD | Muscle tightness | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Throat irritation | · | · | ✓ |
| SD | Upper-airway cough syndrome | · | · | ✓ |
| SD | Urticaria | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release