XWZ-91716-03804
4 vaccinations
7 coded responses
54 check-ins
7 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 080 / NJ
- Registered
- 2021-02-26
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-26
Registered in v-safe
-
2021-02-26
Dose 1 — Moderna
- 2021-02-26
- 2021-02-27
-
2021-02-28
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain, Pain, Pain in extremity — Feeling: Good · Site: PainMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
-
2021-03-12
Survey response — 14 day, dose 1MedDRA: Injection site pruritus, Injection site rash, Sensitive skin — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-03-19
- 2021-03-26
-
2021-03-27
Dose 2 — Moderna
- 2021-03-27
-
2021-03-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches, NauseaAdult check-in
- 2021-03-29
- 2021-03-30
- 2021-03-31
- 2021-04-01
- 2021-04-02
- 2021-04-03
- 2021-04-10
- 2021-04-17
- 2021-04-24
-
2021-05-01
Survey response — 35 day, dose 2MedDRA: Pain in extremity — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-05-08
-
2021-06-26
Survey response — 3 month, dose 2MedDRA: Injection site discolouration, Injection site pruritus, Medical counselling, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-06-26
Report sent to call center — 3 month, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-07-01
- 2021-09-25
-
2021-11-03
Dose 3 — Moderna
-
2021-11-04
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Swelling · Headache, Fatigue or tirednessAdult check-in
-
2021-11-05
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-11-07
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Redness, Swelling, Itching · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-11-08
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Swelling, Itching · Headache, Fatigue or tirednessAdult check-in
-
2021-11-09
Health check-in — days 1–6 daily, dose 3Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-02
- 2021-12-08
- 2021-12-15
- 2022-02-02
-
2022-04-28
Dose 4 — Moderna
-
2022-04-29
Survey response — days 1–6 daily, dose 4MedDRA: Mobility decreased — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body achesMedDRA releases: 2024-11 · check-in answers available
- 2022-04-30
-
2022-05-01
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
-
2022-05-02
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-05-03
- 2022-05-04
- 2022-05-05
- 2022-05-12
- 2022-05-19
-
2022-05-26
Survey response — 28 day, dose 4MedDRA: Cough, Oropharyngeal pain, Respiratory tract congestion — Feeling: FairMedDRA releases: 2024-11 · check-in answers available
- 2022-06-02
- 2022-06-09
-
2022-07-28
Survey response — 3 month, dose 4MedDRA: Exposure to SARS-CoV-2, Malaise, SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11 · check-in answers available
-
2022-07-28
Report sent to call center — 3 month, dose 4Be unable to work or attend school · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-07-29
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-10-29
- 2023-04-28
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-26 | Moderna | |
| 2 | 2021-03-27 | Moderna | |
| 3 | 2021-11-03 | Moderna | No |
| 4 | 2022-04-28 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-06-26 | Successful | Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-07-28 | Successful 2022-07-29 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 4
Systemic reaction (other): After I checked in yesterday the pain got worse and spread a bit to my upper arm but when I woke up this morning is was just at the injection site again.
Release 5
Symptoms: On day 8 and nine my arm near the injection site became very itchy. By Monday the itch stopped but my arm had a rash around the infection site about 4 inches in diameter. It lasted a day or two. After that my arm was sensitive to cloth touching it. cut off by CDC
Release 8
Symptoms: My upper arm that ai got my injection in, suddenly started bothering me this week. It ached most of the week.
Release 9
Symptoms: My arm started to itch again, my injection sight had a brown spot in a circle shape and it began to flake. My dermatologist told me it was a coincidence that it occurred at my injection site but I read that some people were having the same issue
Healthcare visit (other): Dermatologist
Release 11
Systemic reaction (other): Difficulty raising my arm above my shoulder
Symptoms: Cough, sore throat, congested
Release 12
Symptoms: My family developed COVID through exposure from their daycare center. Since I babysit the children I also tested positive but my symptoms were mild.
Free-text releases are not linked to a specific 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 | Office visit | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Exposure to SARS-CoV-2 | · | · | ✓ |
| SD | Injection site discolouration | ✓ | ✓ | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Medical counselling | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sensitive skin | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Mobility decreased | · | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release