VV4-21631-95171
3 vaccinations
3 coded responses
25 check-ins
3 free-text entries
2 call cases
- Sex
- —
- Age at first dose
- 26-30
- ZIP prefix
- 120 / NY
- Registered
- 2021-02-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-04
Dose 1 — Moderna
-
2021-02-01
Dose 2 — Moderna
-
2021-02-04
Registered in v-safe
-
2021-02-04
Survey response — days 1–6 daily, dose 2MedDRA: Lymph node pain — Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tirednessFree text: Pain in lymph nodes in armpit on injection sight sideMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-15
- 2021-02-24
- 2021-03-01
- 2021-03-17
- 2021-05-03
- 2021-08-02
-
2021-11-28
Dose 3 — Moderna
- 2021-11-28
-
2021-11-29
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fever · Chills, Muscle or body aches, Nausea · Be unable to work or attend schoolAdult check-in
- 2021-11-30
- 2021-12-01
- 2021-12-02
- 2021-12-03
- 2021-12-04
- 2021-12-05
- 2021-12-12
-
2021-12-26
Survey response — day 28, dose 3MedDRA: Hospitalisation, Office visit, Urticaria — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Symptoms: Broke out in hives about 10 days after booster · Healthcare visit (other): Went to hospital then followed up with allergistMedDRA releases: 2024-11 · check-in free text available
-
2021-12-26
Report sent to call center — day 28, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2021-12-27
- 2022-01-09
- 2022-02-27
- 2022-05-29
-
2022-11-30
Survey response — 12 months, dose 3MedDRA: Eye allergy, Hypersensitivity — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Allergic reaction in eyes a few days after boosterMedDRA releases: 2024-11 · check-in free text available
-
2022-11-30
Report sent to call center — 12 months, dose 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)
- 2022-12-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-04 | Moderna | |
| 2 | 2021-02-01 | Moderna | |
| 3 | 2021-11-28 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-12-26 | Unsuccessful | |
| 2022-11-30 | Unsuccessful |
Free text
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): Pain in lymph nodes in armpit on injection sight side
Release 10 — day 28, dose 3
Symptoms: Broke out in hives about 10 days after booster
Healthcare visit (other): Went to hospital then followed up with allergist
Release 12 — 12 months, dose 3
Symptoms: Allergic reaction in eyes a few days after booster
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 | Hospitalisation | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Eye allergy | · | · | ✓ |
| SD | Hypersensitivity | · | · | ✓ |
| SD | Urticaria | · | · | ✓ |
| SRO | Lymph node pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release