XYZ-16432-80529
5 vaccinations
10 coded responses
45 check-ins
9 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 546 / WI
- Registered
- 2021-02-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-10
Registered in v-safe
-
2021-02-10
Dose 1 — Moderna
- 2021-02-10
-
2021-02-11
Survey response — days 1–6 daily, dose 1MedDRA: Pain in extremity — Feeling: Poor · Site: Pain · Fever · Chills · Be unable to do your normal daily activitiesMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
-
2021-02-12
Survey response — days 1–6 daily, dose 1MedDRA: Pain, Pain in extremity — Feeling: Good · Site: Pain · Chills, Joint painsMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-03-10
-
2021-03-17
Dose 2 — Moderna
- 2021-03-17
-
2021-03-18
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Itching · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-03-19
Survey response — days 1–6 daily, dose 2MedDRA: Adverse reaction, Unevaluable event — Feeling: Good · Site: Pain, Itching · Fatigue or tirednessMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-03-20
- 2021-03-21
- 2021-03-23
- 2021-03-24
-
2021-03-31
Survey response — 14 day, dose 2MedDRA: Neuralgia — Feeling: GoodMedDRA releases: 2021-09,2023-04,2024-11 · check-in answers available
- 2021-04-08
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-06-17
- 2021-09-15
-
2021-11-05
Dose 3 — Moderna
- 2022-03-17
-
2022-05-13
Dose 4 — Moderna
- 2022-05-13
-
2022-05-14
Survey response — days 1–6 daily, dose 4MedDRA: Insomnia — Feeling: Fair · Site: Pain, Itching · Muscle or body achesMedDRA releases: 2024-11 · check-in answers available
-
2022-05-15
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-05-16
-
2022-05-18
Survey response — days 1–6 daily, dose 4MedDRA: Oropharyngeal pain — Feeling: GoodMedDRA releases: 2024-11 · check-in answers available
- 2022-05-20
- 2022-05-27
- 2022-06-03
- 2022-06-10
- 2022-06-17
- 2022-06-24
- 2022-08-12
-
2022-10-06
Dose 5 — Moderna
- 2022-10-14
-
2022-10-20
Survey response — 14 day, dose 5MedDRA: Pre-existing disease, Respiratory tract congestion — Feeling: FairMedDRA releases: 2024-11 · check-in answers available
- 2022-10-27
-
2022-11-03
Survey response — 28 day, dose 5MedDRA: Cardiac disorder, Pre-existing disease — Feeling: Fair · 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
-
2022-11-03
Report sent to call center — 28 day, 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)
- 2022-11-04
-
2022-11-04
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-11-10
Survey response — 35 day, dose 5MedDRA: Cardiac disorder — Feeling: Fair · 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
-
2022-11-10
Report sent to call center — 35 day, 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)
- 2022-11-11
-
2023-01-05
Survey response — 3 month, dose 5MedDRA: Myocardial infarction — 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 · Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11 · check-in answers available
-
2023-01-05
Report sent to call center — 3 month, dose 5Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2023-01-06
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-01-06
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-04-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-10 | Moderna | |
| 2 | 2021-03-17 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-05-13 | Moderna | No |
| 5 | 2022-10-06 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-11-03 | Successful 2022-11-04 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-11-10 | Successful 2023-01-06 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-01-05 | Successful 2023-01-06 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 4
Systemic reaction (other): The hand on the arm i got the shot ached a little
Systemic reaction (other): Pain shooting though my toes for a couple hours last night
Release 5
Systemic reaction (other): The symtoms I had yesterday lasted about 12 hours and the I started to feel better.
Release 6
Symptoms: A nerve twitching in my hand, minor but annoying.
Release 11
Systemic reaction (other): Could not sleep last night
Systemic reaction (other): Had a very minor sore throat lsst night, probably alergy?
Release 12
Symptoms: Congestion in back of throat. Probably fall allergies ??
Symptoms: Started having symptoms of heart problems. Stress test next week. History of bypass
Symptoms: Heart problems
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 | Cardiac disorder | · | · | ✓ |
| SD | Myocardial infarction | · | · | ✓ |
| SD | Neuralgia | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SRO | Adverse reaction | · | · | ✓ |
| SRO | Insomnia | · | · | ✓ |
| SRO | Oropharyngeal pain | · | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release