T4S-30048-85735

3 vaccinations 7 coded responses 32 check-ins 4 free-text entries 5 call cases

Sex: Male
Age at first dose: 0-4
ZIP prefix: 972 / OR
Registered: 2022-06-22

Relationship: Child or adolescent in my care
Guardian: 369-83887-49966
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2022-06-22
Registered in v-safe
2022-06-22
Dose 1 — Moderna
2022-06-22
Health check-in — day 0, dose 1, dependent
Feeling: Good · Site: Pain, Redness · None

Adult check-in
2022-06-23
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · Site: Pain · Diarrhea

Adult check-in
2022-06-24
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · Site: Pain · None

Adult check-in
2022-06-25
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Fair · Abdominal pain

Adult check-in
2022-06-27
Survey response — days 1–6 daily, dose 1, dependent
MedDRA: Abdominal pain, Constipation — Feeling: Fair · Fever · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activities

Free text: May be heat related? It's >90 degrees. Abdominal pain is constipation

MedDRA releases: 2024-11 · check-in free text available
2022-06-28
Health check-in — days 1–6 daily, dose 1, dependent
Feeling: Good · None

Adult check-in
2022-06-29
Health check-in — day 7, dose 1, dependent
Feeling: Good · None

Adult check-in
2022-07-06
Survey response — day 14, dose 1, dependent
MedDRA: Injection site cellulitis, Injection site rash — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit

Free text: Rash (cellulitis) at injection site. Treated with antibiotic

MedDRA releases: 2024-11 · check-in free text available
2022-07-06
Report sent to call center — day 14, dose 1, dependent
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2022-07-07
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-13
Health check-in — day 21, dose 1, dependent
Feeling: Good

Adult check-in
2022-07-20
Dose 2 — Moderna
2022-07-20
Health check-in — day 0, dose 2, dependent
Feeling: Good · Site: Pain · None

Adult check-in
2022-07-21
Survey response — days 1–6 daily, dose 2, dependent
MedDRA: Pyrexia — Feeling: Poor · Site: Pain, Redness · Fever · Headache, Fatigue or tiredness · 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

Free text: Fever

MedDRA releases: 2024-11 · check-in free text available
2022-07-21
Report sent to call center — days 1–6 daily, dose 2, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-07-22
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Fair · Fever · None

Adult check-in
2022-07-22
Call 1 — Left Voicemail
2022-07-22
Call 1 — Left Voicemail
2022-07-22
Call successful
Participant prefers to complete VAERS report online
2022-07-23
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Site: Redness · None

Adult check-in
2022-07-24
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · None

Adult check-in
2022-07-25
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Diarrhea

Adult check-in
2022-07-26
Health check-in — days 1–6 daily, dose 2, dependent
Feeling: Good · Diarrhea

Adult check-in
2022-07-27
Health check-in — day 7, dose 2, dependent
Feeling: Good · Fever · None

Adult check-in
2022-08-05
Health check-in — day 14, dose 2, dependent
Feeling: Good

Adult check-in
2022-08-10
Health check-in — day 21, dose 2, dependent
Feeling: Good

Adult check-in
2022-08-17
Health check-in — day 28, dose 2, dependent
Feeling: Good

Adult check-in
2022-08-24
Health check-in — day 35, dose 2, dependent
Feeling: Good

Adult check-in
2022-08-31
Health check-in — day 42, dose 2, dependent
Feeling: Good

Adult check-in
2022-10-19
Survey response — 3 months, dose 2, dependent
MedDRA: Diarrhoea, Emergency care, Lethargy, Nasopharyngitis, Pyrexia, Vomiting — 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, Emergency room or emergency department visit

Free text: Cold/virus. High fever (104.6), vomiting, diarrhea, lethargy, visit to the Emergency Room due to high fever.

MedDRA releases: 2024-11 · check-in free text available
2022-10-19
Report sent to call center — 3 months, dose 2, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · Emergency room or emergency department visit · 1 call case(s)
2022-10-20
Call successful
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-12-28
Dose 3 — Moderna
2023-01-03
Health check-in — days 1–6 daily, dose 3, dependent
Feeling: Good · None

Adult check-in
2023-01-06
Health check-in — day 7, dose 3, dependent
Feeling: Poor · Fever · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2023-01-11
Survey response — day 14, dose 3, dependent
MedDRA: Pyrexia — Feeling: Good · Be unable to do your normal daily activities

MedDRA releases: 2024-11
2023-01-20
Health check-in — day 21, dose 3, dependent
Feeling: Good

Adult check-in
2023-01-25
Health check-in — day 28, dose 3, dependent
Feeling: Good

Adult check-in
2023-02-01
Survey response — day 35, dose 3, dependent
MedDRA: Malaise, Nasopharyngitis — 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 · Outpatient clinic or urgent care clinic visit

MedDRA releases: 2024-11
2023-02-01
Report sent to call center — day 35, dose 3, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-02-02
Call 1 — Left Voicemail
2023-02-09
Health check-in — day 42, dose 3, dependent
Feeling: Good

Adult check-in
2023-04-04
Survey response — 3 months, dose 3, dependent
MedDRA: Illness — Feeling: Good · 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

MedDRA releases: 2024-11
2023-04-04
Report sent to call center — 3 months, dose 3, dependent
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Outpatient clinic or urgent care clinic visit · 1 call case(s)
2023-04-05
Call 2 — Left Voicemail
2023-04-05
Call 1 — Left Voicemail
2023-06-28
Health check-in — 6 months, dose 3, dependent
Feeling: Good

Adult check-in

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2022-06-22	Moderna	No
2	2022-07-20	Moderna	No
3	2022-12-28	Moderna	No

Call center

Reported	Outcome	VAERS-related outcome
2022-07-06	Successful 2022-07-07	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2022-07-21	Successful 2022-07-22	Participant prefers to complete VAERS report online
2022-10-19	Successful 2022-10-20	Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
2023-02-01	Unsuccessful
2023-04-04	Unsuccessful

Free text

Release 12 — days 1–6 daily, dose 1, dependent

2022-06-27

Systemic reaction (other): May be heat related? It's >90 degrees. Abdominal pain is constipation

Release 12 — day 14, dose 1, dependent

2022-07-06

Symptoms: Rash (cellulitis) at injection site. Treated with antibiotic

Release 12 — days 1–6 daily, dose 2, dependent

2022-07-21

Systemic reaction (other): Fever

Release 12 — 3 months, dose 2, dependent

2022-10-19

Symptoms: Cold/virus. High fever (104.6), vomiting, diarrhea, lethargy, visit to the Emergency Room due to high fever.

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	Diarrhoea	·	·	✓
SD	Emergency care	·	·	✓
SD	Illness	·	·	✓
SD	Injection site cellulitis	·	·	✓
SD	Injection site rash	·	·	✓
SD	Lethargy	·	·	✓
SD	Malaise	·	·	✓
SD	Nasopharyngitis	·	·	✓
SD	Pyrexia	·	·	✓
SD	Vomiting	·	·	✓
SRO	Abdominal pain	·	·	✓
SRO	Constipation	·	·	✓
SRO	Pyrexia	·	·	✓

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