7KB-24747-72212
4 vaccinations
2 coded responses
3 check-ins
0 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 31-35
- ZIP prefix
- 853 / AZ
- Registered
- 2022-09-18
- Relationship
- Adult relative or friend
- Guardian
- 95X-12858-97451
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-03-26
Dose 1 — Moderna
-
2021-04-22
Dose 2 — Moderna
-
2021-12-02
Dose 3 — Moderna
-
2022-08-05
Dose 4 — Moderna
-
2022-09-18
Registered in v-safe
- 2022-09-18
-
2022-11-04
Survey response — 3 months, dose 4, dependentMedDRA: Cough, Discomfort — Feeling: Poor · Be unable to work or attend schoolMedDRA releases: 2024-11
-
2023-02-03
Survey response — 6 months, dose 4, dependentMedDRA: Dyspnoea, Ear infection, Pharyngeal swelling, Pharyngitis — Feeling: Fair · Be unable to work or attend school, 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 visitMedDRA releases: 2024-11
-
2023-02-03
Report sent to call center — 6 months, dose 4, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2023-02-06
-
2023-02-06
Call successfulParticipant prefers to complete VAERS report online
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-26 | Moderna | No |
| 2 | 2021-04-22 | Moderna | No |
| 3 | 2021-12-02 | Moderna | No |
| 4 | 2022-08-05 | Moderna | No |
Call center
1 call center case
1 successful
Free text
None.
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 | Discomfort | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Ear infection | · | · | ✓ |
| SD | Pharyngeal swelling | · | · | ✓ |
| SD | Pharyngitis | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release