BXA-11127-40378
4 vaccinations
2 coded responses
24 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 381 / TN
- Registered
- 2021-10-27
- Relationship
- Adult relative or friend
- Guardian
- YVK-18948-99645
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-08
Dose 1 — Moderna
-
2021-04-06
Dose 2 — Moderna
-
2021-10-26
Dose 3 — Moderna
-
2021-10-27
Registered in v-safe
-
2021-10-27
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-10-28
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-10-29
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Fair · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-10-30
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-10-31
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Fair · Fever · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-11-01
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-11-02
- 2021-11-09
- 2021-11-18
- 2021-11-23
- 2021-12-07
- 2022-04-26
-
2022-11-22
Dose 4 — Pfizer-BioNTech
-
2022-11-24
Health check-in — days 1–6 daily, dose 4, dependentFeeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2022-11-26
- 2022-11-27
-
2022-11-28
Survey response — days 1–6 daily, dose 4, dependentMedDRA: Hyperhidrosis — Feeling: Fair · FeverFree text: Sweat above mouthMedDRA releases: 2024-11 · check-in free text available
- 2022-11-29
- 2022-12-06
-
2022-12-13
Survey response — day 21, dose 4, dependentMedDRA: Sinusitis, Upper respiratory tract infection — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Developing sinus and URI infection.MedDRA releases: 2024-11 · check-in free text available
-
2022-12-13
Report sent to call center — day 21, 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 prTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-12-14
-
2022-12-16
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-12-22
- 2022-12-27
- 2023-01-03
- 2023-02-21
- 2023-05-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-08 | Moderna | No |
| 2 | 2021-04-06 | Moderna | No |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-11-22 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-12-13 | Successful 2022-12-16 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 12 — days 1–6 daily, dose 4, dependent
Systemic reaction (other): Sweat above mouth
Release 12 — day 21, dose 4, dependent
Symptoms: Developing sinus and URI 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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| SD | Sinusitis | · | · | ✓ |
| SD | Upper respiratory tract infection | · | · | ✓ |
| SRO | Hyperhidrosis | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release