N9J-84475-44690
1 vaccination
3 coded responses
4 check-ins
0 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 432 / OH
- Registered
- 2023-04-12
- Relationship
- Child or adolescent in my care
- Guardian
- 8QC-45820-35646
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2023-03-24
Dose 1 — ModernaCo-administered: Hepatitis B:Hib:Pneumonia:Polio:Tetanus
-
2023-04-12
Registered in v-safe
-
2023-04-12
Survey response — day 14, dose 1, under 3MedDRA: Conjunctivitis, Eczema, Impetigo, Influenza virus test negative, Pre-existing disease, SARS-CoV-2 test negative, Viral upper respiratory tract infection — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-04-12
Report sent to call center — day 14, dose 1, under 3Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2023-04-13
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-04-28
Survey response — day 35, dose 1, under 3MedDRA: Cough, SARS-CoV-2 test negative, Viral upper respiratory tract infection — Feeling: GoodMedDRA releases: 2024-11
- 2023-05-05
-
2023-06-23
Survey response — 3 months, dose 1, under 3MedDRA: Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend schoolMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2023-03-24 | Moderna | Hepatitis B:Hib:Pneumonia:Polio:Tetanus |
Call center
1 call center case
1 successful
Free text
None.
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 | Conjunctivitis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Eczema | · | · | ✓ |
| SD | Impetigo | · | · | ✓ |
| SD | Influenza virus test negative | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Viral upper respiratory tract infection | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release