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F85-20705-35431

3 vaccinations 4 coded responses 28 check-ins 3 free-text entries 4 call cases
Sex
Male
Age at first dose
0-4
ZIP prefix
633 / MO
Registered
2022-06-22
Relationship
Child or adolescent in my care
Guardian
ZB9-23954-91313
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2022-06-22
    Registered in v-safe
  2. 2022-09-26
    Dose 1 — Moderna
    Co-administered: Flu:Hepatitis B:Hib:Polio:Rotavirus:Tetanus
  3. 2022-10-09
    Health check-in — day 7, dose 1, under 3
    Feeling: Good · None
    Under 3 check-in
  4. 2022-10-10
    Health check-in — day 14, dose 1, under 3
    Feeling: Good
    Under 3 check-in
  5. 2022-10-17
    Health check-in — day 21, dose 1, under 3
    Feeling: Good
    Under 3 check-in
  6. 2022-10-24
    Health check-in — day 28, dose 1, under 3
    Feeling: Good
    Under 3 check-in
  7. 2022-10-27
    Dose 2 — Moderna
    Co-administered: Flu
  8. 2022-10-31
    Health check-in — days 1–6 daily, dose 2, under 3
    Feeling: Good · None
    Under 3 check-in
  9. 2022-11-01
    Health check-in — days 1–6 daily, dose 2, under 3
    Feeling: Good · None
    Under 3 check-in
  10. 2022-11-02
    Health check-in — days 1–6 daily, dose 2, under 3
    Feeling: Good · None
    Under 3 check-in
  11. 2022-11-03
    Health check-in — day 7, dose 2, under 3
    Feeling: Good · None
    Under 3 check-in
  12. 2022-11-10
    Survey response — day 14, dose 2, under 3
    MedDRA: Croup infectious, Stridor, Use of accessory respiratory muscles — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit
    Free text: Severe croup, with stridor and rib retractions
    MedDRA releases: 2024-11 · check-in free text available
  13. 2022-11-10
    Report sent to call center — day 14, dose 2, under 3
    Be unable to work or attend school · Get care from a doctor or other healthcare professional
    Emergency room or emergency department visit · 1 call case(s)
  14. 2022-11-11
  15. 2022-11-11
    Call successful
    Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
  16. 2022-11-17
    Survey response — day 21, dose 2, under 3
    MedDRA: Ear infection — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Double ear infection
    MedDRA releases: 2024-11 · check-in free text available
  17. 2022-11-17
    Report sent to call center — day 21, dose 2, under 3
    Be unable to work or attend school · Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  18. 2022-11-18
  19. 2022-11-24
    Health check-in — day 28, dose 2, under 3
    Feeling: Good
    Under 3 check-in
  20. 2022-12-01
    Health check-in — day 35, dose 2, under 3
    Feeling: Good
    Under 3 check-in
  21. 2022-12-08
    Survey response — day 42, dose 2, under 3
    MedDRA: Croup infectious, Ear infection — Feeling: Poor · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: New bout of croup and double ear infection
    MedDRA releases: 2024-11 · check-in free text available
  22. 2022-12-08
    Report sent to call center — day 42, dose 2, under 3
    Be unable to work or attend school · Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  23. 2022-12-09
  24. 2022-12-09
  25. 2023-01-26
    Dose 3 — Moderna
  26. 2023-01-26
    Health check-in — 3 months, dose 2, under 3
    Feeling: Good
    Under 3 check-in
  27. 2023-01-26
    Health check-in — day 0, dose 3, under 3
    Feeling: Good · None
    Under 3 check-in
  28. 2023-01-27
    Health check-in — days 1–6 daily, dose 3, under 3
    Feeling: Good · Sleepiness
    Under 3 check-in
  29. 2023-01-28
    Health check-in — days 1–6 daily, dose 3, under 3
    Feeling: Good · None
    Under 3 check-in
  30. 2023-01-29
    Health check-in — days 1–6 daily, dose 3, under 3
    Feeling: Good · None
    Under 3 check-in
  31. 2023-01-30
    Health check-in — days 1–6 daily, dose 3, under 3
    Feeling: Good · Vomiting, Diarrhea
    Under 3 check-in
  32. 2023-01-31
    Health check-in — days 1–6 daily, dose 3, under 3
    Feeling: Good · Diarrhea
    Under 3 check-in
  33. 2023-02-01
    Health check-in — days 1–6 daily, dose 3, under 3
    Feeling: Good · None
    Under 3 check-in
  34. 2023-02-02
    Survey response — day 7, dose 3, under 3
    MedDRA: Croup infectious, Stridor — Feeling: Fair · Sleepiness · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    MedDRA releases: 2024-11
  35. 2023-02-02
    Report sent to call center — day 7, dose 3, under 3
    Be unable to work or attend school · Get care from a doctor or other healthcare professional
    Outpatient clinic or urgent care clinic visit · 1 call case(s)
  36. 2023-02-03
  37. 2023-02-03
  38. 2023-02-03
  39. 2023-02-09
    Health check-in — day 14, dose 3, under 3
    Feeling: Good
    Under 3 check-in
  40. 2023-02-16
    Health check-in — day 21, dose 3, under 3
    Feeling: Good
    Under 3 check-in
  41. 2023-02-23
    Health check-in — day 28, dose 3, under 3
    Feeling: Good
    Under 3 check-in
  42. 2023-03-02
    Health check-in — day 35, dose 3, under 3
    Feeling: Good
    Under 3 check-in
  43. 2023-03-09
    Health check-in — day 42, dose 3, under 3
    Feeling: Fair
    Under 3 check-in
  44. 2023-04-27
    Health check-in — 3 months, dose 3, under 3
    Feeling: Good
    Under 3 check-in

Vaccinations

DoseDateManufacturerCo-administered
12022-09-26Moderna Flu:Hepatitis B:Hib:Polio:Rotavirus:Tetanus
22022-10-27Moderna Flu
32023-01-26Moderna No

Call center

ReportedOutcomeVAERS-related outcome
2022-11-10 Successful
2022-11-11
 Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-11-17 Unsuccessful
2022-12-08 Unsuccessful
2023-02-02 Unsuccessful

Free text

Release 12 (Under 3) — day 14, dose 2, under 3

2022-11-10

Symptoms: Severe croup, with stridor and rib retractions

Release 12 (Under 3) — day 21, dose 2, under 3

2022-11-17

Symptoms: Double ear infection

Release 12 (Under 3) — day 42, dose 2, under 3

2022-12-08

Symptoms: New bout of croup and double ear 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
SDCroup infectious · · ✓
SDEar infection · · ✓
SDStridor · · ✓
SDUse of accessory respiratory muscles · · ✓
SROCroup infectious · · ✓
SROStridor · · ✓

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

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