VT4-33663-90621
1 vaccination
3 coded responses
10 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 921 / CA
- Registered
- 2022-06-26
- Relationship
- Child or adolescent in my care
- Guardian
- VPV-22796-91166
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-24
Dose 1 — Moderna
-
2022-06-26
Registered in v-safe
- 2022-06-27
-
2022-06-28
Survey response — days 1–6 daily, dose 1, under 3MedDRA: Rash — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Mysterious mild rash around collarbone area developed the following day after injection. Lasted for about 24hrs, now goneMedDRA releases: 2024-11 · check-in free text available
- 2022-06-29
- 2022-06-30
- 2022-07-01
- 2022-07-08
- 2022-07-17
-
2022-09-25
Survey response — 3 months, dose 1, under 3MedDRA: Nasopharyngitis, SARS-CoV-2 test negative, Upper respiratory tract infection — 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 visitFree text: Back to back URI / cold viruses. Both times tested for Covid, both times negative.MedDRA releases: 2024-11 · check-in free text available
-
2022-09-25
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 · 1 call case(s)
- 2022-09-26
-
2022-12-23
Survey response — 6 months, dose 1, under 3MedDRA: Influenza — 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 visitFree text: Influenza A. 10 daysMedDRA releases: 2024-11 · check-in free text available
-
2022-12-23
Report sent to call center — 6 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 · 1 call case(s)
- 2022-12-27
- 2022-12-27
- 2023-06-24
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-06-24 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-09-25 | Unsuccessful | |
| 2022-12-23 | Unsuccessful |
Free text
Release 12 (Under 3) — days 1–6 daily, dose 1, under 3
Systemic reaction (other): Mysterious mild rash around collarbone area developed the following day after injection. Lasted for about 24hrs, now gone
Release 12 (Under 3) — 3 months, dose 1, under 3
Symptoms: Back to back URI / cold viruses. Both times tested for Covid, both times negative.
Release 12 (Under 3) — 6 months, dose 1, under 3
Symptoms: Influenza A. 10 days
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 | Influenza | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Upper respiratory tract infection | · | · | ✓ |
| SRO | Rash | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release