FZ7-54119-24856
5 vaccinations
2 coded responses
14 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 067 / CT
- Registered
- 2022-11-04
- Relationship
- Adult relative or friend
- Guardian
- 63K-15475-83371
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-20
Dose 1 — Moderna
-
2021-03-26
Dose 2 — Moderna
-
2021-10-29
Dose 3 — Moderna
-
2022-04-09
Dose 4 — Moderna
-
2022-11-04
Registered in v-safe
-
2022-11-04
Dose 5 — Moderna
- 2022-11-04
- 2022-11-06
- 2022-11-07
- 2022-11-08
- 2022-11-09
- 2022-11-10
- 2022-11-11
- 2022-11-18
-
2022-11-25
Survey response — day 21, dose 5, dependentMedDRA: Fatigue, Headache, Office visit, Pain, Productive cough, Respiratory tract congestion — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: head congestion, headache, cough with phelgm, body aches and pains, fatigue · Healthcare visit (other): saw PCP at officeMedDRA releases: 2024-11 · check-in free text available
-
2022-11-25
Report sent to call center — day 21, dose 5, dependentBe unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2022-11-28
Call successfulCompleted over the phone
-
2022-12-02
Survey response — day 28, dose 5, dependentMedDRA: Headache, Oropharyngeal pain — Feeling: Fair · Be unable to do your normal daily activitiesFree text: sore throat and continued headachesMedDRA releases: 2024-11 · check-in free text available
- 2022-12-09
- 2022-12-16
- 2023-02-03
- 2023-05-05
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-20 | Moderna | No |
| 2 | 2021-03-26 | Moderna | No |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-04-09 | Moderna | No |
| 5 | 2022-11-04 | Moderna | No |
Call center
1 call center case
1 successful
VAERS report filed, before or during a call: 1
Free text
Release 12 — day 21, dose 5, dependent
Symptoms: head congestion, headache, cough with phelgm, body aches and pains, fatigue
Healthcare visit (other): saw PCP at office
Release 12 — day 28, dose 5, dependent
Symptoms: sore throat and continued headaches
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 |
|---|---|---|---|---|
| HCVO | Office visit | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Productive cough | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release