DVV-11690-25768
2 vaccinations
3 coded responses
17 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 209 / MD
- Registered
- 2022-06-23
- Relationship
- Child or adolescent in my care
- Guardian
- XFK-11704-38165
- Race
- Multiracial
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-22
Dose 1 — Moderna
-
2022-06-23
Registered in v-safe
-
2022-06-23
Health check-in — days 1–6 daily, dose 1, dependentFeeling: Good · Fatigue or tiredness, Abdominal painAdult check-in
- 2022-06-24
- 2022-06-25
- 2022-06-26
- 2022-06-27
- 2022-06-29
- 2022-07-06
-
2022-07-22
Dose 2 — Moderna
- 2022-07-22
- 2022-07-27
- 2022-07-28
- 2022-07-29
- 2022-08-05
-
2022-08-19
Survey response — day 28, dose 2, dependentMedDRA: Urticaria — 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 visitFree text: Potential Viral infection with full body hivesMedDRA releases: 2024-11 · check-in free text available
-
2022-08-19
Report sent to call center — day 28, dose 2, 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 · 1 call case(s)
-
2022-08-22
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-08-26
-
2022-09-04
Survey response — day 42, dose 2, dependentMedDRA: Heat exhaustion — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Heat exhaustion probably from playing outsideMedDRA releases: 2024-11 · check-in free text available
- 2022-10-21
-
2023-01-20
Survey response — 6 months, dose 2, dependentMedDRA: Cough, Rhinorrhoea — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activitiesMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-06-22 | Moderna | No |
| 2 | 2022-07-22 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-08-19 | Successful 2022-08-22 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 12 — day 28, dose 2, dependent
Symptoms: Potential Viral infection with full body hives
Release 12 — day 42, dose 2, dependent
Symptoms: Heat exhaustion probably from playing outside
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 | Heat exhaustion | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release