XXG-32126-71999
4 vaccinations
4 coded responses
35 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 130 / NY
- Registered
- 2021-01-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-15
Registered in v-safe
-
2021-01-15
Dose 1 — Moderna
- 2021-01-15
-
2021-01-16
Survey response — days 1–6 daily, dose 1MedDRA: Hepatic pain — Feeling: Good · Site: Pain · HeadacheMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-01-17
- 2021-01-18
- 2021-01-21
- 2021-01-22
- 2021-01-29
- 2021-02-05
-
2021-02-12
Dose 2 — Moderna
- 2021-02-12
-
2021-02-13
Survey response — days 1–6 daily, dose 2MedDRA: Depressed mood — Feeling: Good · Site: Pain · Fatigue or tirednessMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-26
- 2021-03-05
- 2021-03-12
- 2021-08-13
-
2021-10-26
Dose 3 — Moderna
- 2021-10-30
- 2021-10-31
- 2021-11-01
-
2021-11-02
Survey response — 7 day, dose 3MedDRA: Feeling cold — Feeling: GoodMedDRA releases: 2024-11 · check-in answers available
- 2021-11-09
- 2021-11-17
- 2021-11-26
- 2021-11-30
- 2021-12-07
- 2022-01-25
-
2022-04-05
Dose 4 — Moderna
-
2022-04-22
Survey response — 14 day, dose 4MedDRA: Chest pain, Deep vein thrombosis, Emergency care, Office visit, Pulmonary embolism — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11 · check-in answers available
-
2022-04-22
Report sent to call center — 14 day, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2022-04-25
Call successfulParticipant prefers to complete VAERS report online
- 2022-04-26
- 2022-05-04
- 2022-05-10
- 2022-05-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-15 | Moderna | |
| 2 | 2021-02-12 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-04-05 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-04-22 | Successful 2022-04-25 |
Participant prefers to complete VAERS report online |
Free text
Release 2
Systemic reaction (other): Slight pain in the region of the liver about 12 hours after vaccination - not a problem but noticeable. Went away shortly after I lay down.
Release 4
Systemic reaction (other): Feeling just kinda dull - no pain, no feeling sick, just blah.
Release 10
Systemic reaction (other): Feeling a little "cold-y" especially when I woke up.
Release 11
Symptoms: Feb 19-21. Following severe chest pains on backside of chest early AM Feb 19 and a trip to the ER, diagnosed with idiopathic DVT & PE. Now taking Eliquis, and having follow-up consultations with hematologist.
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 |
|---|---|---|---|---|
| SD | Chest pain | · | · | ✓ |
| SD | Deep vein thrombosis | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pulmonary embolism | · | · | ✓ |
| SRO | Depressed mood | ✓ | ✓ | ✓ |
| SRO | Feeling cold | · | · | ✓ |
| SRO | Hepatic pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release