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K4D-20285-11342

5 vaccinations 4 coded responses 41 check-ins 4 free-text entries 2 call cases
Sex
Female
Age at first dose
26-30
ZIP prefix
376 / TN
Registered
2020-12-30
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino
Registered dependents
53J-13263-91995 Child or adolescent in my care · Male · 2022-07-01
MBL-38626-42845 Child or adolescent in my care · Male · 2022-07-01

Timeline

  1. 2020-12-30
    Registered in v-safe
  2. 2020-12-30
    Dose 1 — Moderna
  3. 2020-12-30
    Health check-in — day 0, dose 1
    Feeling: Good · None
    Adult check-in
  4. 2020-12-31
    Survey response — days 1–6 daily, dose 1
    MedDRA: Rhinorrhoea — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness
    Free text: Nasal drainage
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-01-01
    Survey response — days 1–6 daily, dose 1
    MedDRA: Ear pain — Feeling: Fair · Headache · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Moderate Eustachian tube pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-01
    Report sent to call center — days 1–6 daily, dose 1
    Get care from a doctor or other healthcare professional
    1 call case(s)
  7. 2021-01-02
    Survey response — days 1–6 daily, dose 1
    MedDRA: Ear pain — Feeling: Fair · Headache, Joint pains, Fatigue or tiredness
    Free text: Moderate ear pain
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-01-03
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-01-04
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-01-06
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-01-13
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-01-21
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-01-26
    Call successful
    Does not wish to fill out VAERS report
  14. 2021-01-27
    Dose 2 — Moderna
  15. 2021-01-27
    Health check-in — day 0, dose 2
    Feeling: Good · Site: Pain · None
    Adult check-in
  16. 2021-01-28
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Pain · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness
    Adult check-in
  17. 2021-01-29
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · Chills
    Adult check-in
  18. 2021-01-30
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-01-31
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-02-01
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-02-02
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Headache
    Adult check-in
  22. 2021-02-03
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  23. 2021-02-10
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-02-17
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-02-24
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-03-03
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-03-10
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-04-28
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  29. 2021-07-28
    Survey response — 6 months, dose 2
    MedDRA: Asthma late onset, Pre-existing disease — 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 consultation, Outpatient clinic or urgent care clinic visit
    Free text: Adult onset asthma due to allergies
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  30. 2021-07-28
    Report sent to call center — 6 months, dose 2
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    1 call case(s)
  31. 2021-08-03
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  32. 2021-08-16
    Dose 3 — Moderna
  33. 2021-11-15
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  34. 2022-01-16
    Dose 4 — Moderna
  35. 2022-02-14
    Health check-in — 6 months, dose 3
    Feeling: Good
    Adult check-in
  36. 2022-07-17
    Health check-in — 6 months, dose 4
    Feeling: Good
    Adult check-in
  37. 2022-09-07
    Dose 5 — Moderna
    Co-administered: Flu:Tetanus
  38. 2022-09-07
    Health check-in — day 0, dose 5
    Feeling: Good · Site: Pain · Fatigue or tiredness
    Adult check-in
  39. 2022-09-08
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · Site: Pain · Headache
    Adult check-in
  40. 2022-09-09
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · Site: Pain · Headache
    Adult check-in
  41. 2022-09-10
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  42. 2022-09-11
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  43. 2022-09-12
    Health check-in — days 1–6 daily, dose 5
    Feeling: Good · None
    Adult check-in
  44. 2022-09-16
    Health check-in — day 7, dose 5
    Feeling: Good · None
    Adult check-in
  45. 2022-09-21
    Health check-in — day 14, dose 5
    Feeling: Good
    Adult check-in
  46. 2022-09-28
    Health check-in — day 21, dose 5
    Feeling: Good
    Adult check-in
  47. 2022-10-05
    Health check-in — day 28, dose 5
    Feeling: Good
    Adult check-in
  48. 2022-10-12
    Health check-in — day 35, dose 5
    Feeling: Good
    Adult check-in
  49. 2022-10-19
    Health check-in — day 42, dose 5
    Feeling: Good
    Adult check-in
  50. 2022-12-07
    Health check-in — 3 months, dose 5
    Feeling: Good
    Adult check-in
  51. 2023-03-08
    Health check-in — 6 months, dose 5
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12020-12-30Moderna
22021-01-27Moderna
32021-08-16Moderna No
42022-01-16Moderna No
52022-09-07Moderna Flu:Tetanus

Call center

2 call center cases

2 successful

See the call center timeline

Free text

Release 1 — days 1–6 daily, dose 1

2020-12-31

Systemic reaction (other): Nasal drainage

2021-01-01

Systemic reaction (other): Moderate Eustachian tube pain

2021-01-02

Systemic reaction (other): Moderate ear pain

Release 9 — 6 months, dose 2

2021-07-28

Symptoms: Adult onset asthma due to allergies

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
SDAsthma late onset ✓ · ✓
SDPre-existing disease ✓ · ✓
SROEar pain ✓ ✓ ✓
SRORhinorrhoea ✓ ✓ ✓

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

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