T86-11882-75624
5 vaccinations
2 coded responses
38 check-ins
2 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 377 / TN
- Registered
- 2021-12-11
- Relationship
- Adult relative or friend
- Guardian
- Z8G-59901-35037
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-25
Dose 1 — Moderna
-
2021-04-26
Dose 2 — Moderna
-
2021-12-09
Dose 3 — Moderna
-
2021-12-11
Registered in v-safe
- 2021-12-11
- 2021-12-12
- 2021-12-15
- 2021-12-16
- 2021-12-25
- 2022-01-01
- 2022-01-08
- 2022-01-13
- 2022-01-22
- 2022-03-11
-
2022-06-11
Survey response — 6 months, dose 3, dependentMedDRA: Diverticulitis, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Diverticulitis · Healthcare visit (other): Doctor appointmentMedDRA releases: 2024-11 · check-in free text available
-
2022-06-11
Report sent to call center — 6 months, dose 3, dependentGet care from a doctor or other healthcare professional1 call case(s)
- 2022-06-13
-
2022-06-13
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-07-08
Dose 4 — Moderna
-
2022-07-09
Health check-in — days 1–6 daily, dose 4, dependentFeeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-07-10
Health check-in — days 1–6 daily, dose 4, dependentFeeling: Good · Site: Pain, Redness, Swelling · NoneAdult check-in
-
2022-07-11
Health check-in — days 1–6 daily, dose 4, dependentFeeling: Good · Site: Redness · NoneAdult check-in
-
2022-07-12
Health check-in — days 1–6 daily, dose 4, dependentFeeling: Good · Site: Redness · NoneAdult check-in
- 2022-07-13
- 2022-07-14
- 2022-07-15
- 2022-07-22
- 2022-07-31
- 2022-08-05
- 2022-08-12
- 2022-08-21
-
2022-10-08
Survey response — 3 months, dose 4, dependentMedDRA: Diverticulitis, Medical counselling, Pre-existing disease — Feeling: Poor · Get care from a doctor or other healthcare professionalFree text: Symptoms: Diverticulitis flare · Healthcare visit (other): Call to doctor and CAT scanMedDRA releases: 2024-11 · check-in free text available
-
2022-10-08
Report sent to call center — 3 months, dose 4, dependentGet care from a doctor or other healthcare professional1 call case(s)
- 2022-10-10
- 2023-01-06
-
2023-01-12
Dose 5 — Moderna
-
2023-01-13
Health check-in — days 1–6 daily, dose 5, dependentFeeling: Good · Site: Pain · NoneAdult check-in
- 2023-01-14
- 2023-01-15
- 2023-01-16
- 2023-01-17
- 2023-01-18
- 2023-01-19
- 2023-01-26
- 2023-02-02
- 2023-02-09
- 2023-02-16
- 2023-02-23
- 2023-04-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-25 | Moderna | No |
| 2 | 2021-04-26 | Moderna | No |
| 3 | 2021-12-09 | Moderna | No |
| 4 | 2022-07-08 | Moderna | No |
| 5 | 2023-01-12 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-06-11 | Successful 2022-06-13 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-10-08 | Unsuccessful |
Free text
Release 12 — 6 months, dose 3, dependent
Release 12 — 3 months, dose 4, dependent
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 | Medical counselling | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Diverticulitis | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release