XYP-21693-51010
5 vaccinations
9 coded responses
47 check-ins
8 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 836 / ID
- Registered
- 2021-02-02
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-02
Registered in v-safe
-
2021-02-02
Dose 1 — Moderna
-
2021-02-02
Survey response — 0 day, dose 1MedDRA: No adverse event, Unevaluable event — Feeling: Fair · Fatigue or tirednessMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-03
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: Good · Site: Pain · Fatigue or tirednessMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-04
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: Good · Site: Pain · Fatigue or tirednessMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-16
- 2021-02-23
-
2021-03-02
Dose 2 — Moderna
- 2021-03-02
- 2021-03-03
-
2021-03-04
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness · Fever · Fatigue or tirednessAdult check-in
-
2021-03-05
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Itching · DiarrheaAdult check-in
-
2021-03-06
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Itching · NoneAdult check-in
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-16
- 2021-03-23
-
2021-03-30
Survey response — 28 day, dose 2MedDRA: Diarrhoea, Gastroenteritis viral — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-04-06
- 2021-04-13
-
2021-06-01
Survey response — 3 month, dose 2MedDRA: Chest discomfort, Oropharyngeal pain, Rhinorrhoea — Feeling: Good · Be unable to do your normal daily activitiesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-08-31
-
2021-10-15
Dose 3 — Moderna
-
2021-10-26
Survey response — 7 day, dose 3MedDRA: Arthralgia, Chills, Middle insomnia, Night sweats, Self-medication — Feeling: GoodMedDRA releases: 2024-11 · check-in answers available
- 2021-10-29
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-27
- 2022-01-14
-
2022-04-08
Dose 4 — Moderna
-
2022-04-17
Survey response — 7 day, dose 4MedDRA: Feeling cold — Feeling: Good · ChillsMedDRA releases: 2024-11 · check-in answers available
- 2022-04-22
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-07-08
-
2022-09-22
Dose 5 — Pfizer-BioNTechCo-administered: Flu
- 2022-09-30
- 2022-10-06
- 2022-10-13
- 2022-10-20
- 2022-10-27
- 2022-11-03
-
2022-12-27
Survey response — 3 month, dose 5MedDRA: Influenza, Office visit, Pulmonary congestion, Pyrexia — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11 · check-in answers available
-
2022-12-27
Report sent to call center — 3 month, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-12-29
-
2023-01-04
Call successfulDoes not wish to fill out VAERS report
-
2023-03-23
Survey response — 6 month, dose 5MedDRA: Laboratory test abnormal — Feeling: Good · Be unable to do your normal daily activitiesMedDRA releases: 2024-11 · check-in answers available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-02 | Moderna | |
| 2 | 2021-03-02 | Moderna | |
| 3 | 2021-10-15 | Moderna | No |
| 4 | 2022-04-08 | Moderna | No |
| 5 | 2022-09-22 | Pfizer-BioNTech | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-12-27 | Successful 2023-01-04 |
Does not wish to fill out VAERS report |
Free text
Release 3
Systemic reaction (other): Na
Systemic reaction (other): Na
Release 6
Symptoms: Diarrhea and stomach bug
Release 8
Symptoms: Runnie nose sore throat chest congestion in past two weeks
Release 10
Systemic reaction (other): Day after 3rd injection woke in night sweating chills joint pain TYLENOL HELPED IMMENSELY
Release 11
Systemic reaction (other): Feel cold no matter how much clothing I wear.
Release 12
Symptoms: November 14 had Influenza A temp 102.8 to103.2 temp. Went to urgent care was prescribed antibiotics for Congestion in my lungs. Took about a week to recover, and another week to get back to close normal. very well as of this time. was in SoCal visiti cut off by CDC
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 discomfort | ✓ | ✓ | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Gastroenteritis viral | ✓ | ✓ | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Laboratory test abnormal | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Pulmonary congestion | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinorrhoea | ✓ | ✓ | ✓ |
| SRO | Arthralgia | · | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Feeling cold | · | · | ✓ |
| SRO | Middle insomnia | · | · | ✓ |
| SRO | Night sweats | · | · | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Self-medication | · | · | ✓ |
| SRO | Unevaluable event | ○ | ✓ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release