Y23-15906-73082
2 vaccinations
8 coded responses
22 check-ins
8 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 488 / MI
- Registered
- 2021-02-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-19
Registered in v-safe
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2021-02-19
Dose 1 — Moderna
- 2021-02-19
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2021-02-20
Survey response — days 1–6 daily, dose 1MedDRA: Respiratory tract congestion — Feeling: GoodFree text: Congested overnightMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-21
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus, Rhinorrhoea — Feeling: FairFree text: 2nd day if runny and itching nose. My wife has same symptoms and we both had the shot at the same time. Could just be a cold. Have not had any illness in over a year. May be a coincidence.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-22
Survey response — days 1–6 daily, dose 1MedDRA: Nasopharyngitis, Rhinorrhoea — Feeling: FairFree text: Running nose. Must be a coldMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-23
Survey response — days 1–6 daily, dose 1MedDRA: Nasopharyngitis — Feeling: GoodFree text: Defiantly a cold. Starting to get somewhat better!!!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-24
Survey response — days 1–6 daily, dose 1MedDRA: Lower respiratory tract infection — Feeling: GoodFree text: Cold moving to chest other than that great!!!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-26
Survey response — day 7, dose 1MedDRA: Nasopharyngitis — Feeling: GoodFree text: Cold symptoms are almost gone.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-05
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2021-03-12
Survey response — day 21, dose 1MedDRA: Dyspnoea exertional, Neck pain, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Last Monday went swimming and had troubles breathing. Went Tuesday night same thing. Went to the Dr office and they told me to stop exercising and swimming. Took blood, chest X-ray and now waiting to get a echocardiogram. Also neck pain. · Healthcare visit (other): Went to my Dr office. I did not have another Covid test.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-12
Report sent to call center — day 21, dose 1Get care from a doctor or other healthcare professional1 call case(s)
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2021-03-19
Dose 2 — Moderna
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-03-25
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-04-23
- 2021-04-30
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2021-06-18
Survey response — 3 months, dose 2MedDRA: Dyspnoea, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Issue breathing · Healthcare visit (other): 7 tests for heart lungs and blood.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-18
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-21
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2021-06-21
Callback requested for02:00PM ET
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2021-06-21
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-09-20
- 2022-03-19
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-19 | Moderna | |
| 2 | 2021-03-19 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-12 | Successful | Completed over the phone |
| 2021-06-18 | Successful 2021-06-21 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Congested overnight
Systemic reaction (other): 2nd day if runny and itching nose. My wife has same symptoms and we both had the shot at the same time. Could just be a cold. Have not had any illness in over a year. May be a coincidence.
Systemic reaction (other): Running nose. Must be a cold
Systemic reaction (other): Defiantly a cold. Starting to get somewhat better!!!
Systemic reaction (other): Cold moving to chest other than that great!!!
Release 4 — day 7, dose 1
Systemic reaction (other): Cold symptoms are almost gone.
Release 5 — day 21, dose 1
Symptoms: Last Monday went swimming and had troubles breathing. Went Tuesday night same thing. Went to the Dr office and they told me to stop exercising and swimming. Took blood, chest X-ray and now waiting to get a echocardiogram. Also neck pain.
Healthcare visit (other): Went to my Dr office. I did not have another Covid test.
Release 9 — 3 months, dose 2
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 | Office visit | ✓ | ✓ | ✓ |
| HCVO | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Dyspnoea exertional | ✓ | ✓ | ✓ |
| SD | Neck pain | ✓ | ✓ | ✓ |
| SRO | Lower respiratory tract infection | ✓ | ✓ | ✓ |
| SRO | Nasopharyngitis | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Respiratory tract congestion | ✓ | ✓ | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release