N5Z-23719-37917
1 vaccination
1 coded response
6 check-ins
1 free-text entry
1 call case
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 483 / MI
- Registered
- 2022-06-28
- Relationship
- Child or adolescent in my care
- Guardian
- W65-10197-65573
- Race
- Other
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-27
Dose 1 — Moderna
-
2022-06-28
Registered in v-safe
- 2022-06-28
- 2022-06-29
-
2022-07-02
Health check-in — days 1–6 daily, dose 1, under 3Feeling: Good · Irritability/cryingUnder 3 check-in
- 2022-07-04
- 2022-07-18
-
2022-09-29
Survey response — 3 months, dose 1, under 3MedDRA: COVID-19, Respiratory disorder — 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 visit, Emergency room or emergency department visit, HospitalizationFree text: Covid, respiratory illnessMedDRA releases: 2024-11 · check-in free text available
-
2022-09-29
Report sent to call center — 3 months, dose 1, under 3Be 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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2022-09-30
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-06-27 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-09-29 | Successful 2022-09-30 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 12 (Under 3) — 3 months, dose 1, under 3
Symptoms: Covid, respiratory illness
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 | COVID-19 | · | · | ✓ |
| SD | Respiratory disorder | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release