Y3Y-17934-50389
5 vaccinations
6 coded responses
59 check-ins
6 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 605 / IL
- Registered
- 2021-03-23
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-23
Registered in v-safe
-
2021-03-23
Dose 1 — Moderna
- 2021-03-23
- 2021-03-24
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2021-03-25
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Swelling · Headache, Joint pains, Fatigue or tirednessAdult check-in
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2021-03-26
Survey response — days 1–6 daily, dose 1MedDRA: Night sweats — Feeling: Good · Joint painsFree text: Night sweats last night. Getting a good immune response from vax it seems.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-27
- 2021-03-28
- 2021-03-29
- 2021-03-30
-
2021-04-06
Survey response — day 14, dose 1MedDRA: Injection site pruritus, Injection site rash — Feeling: GoodFree text: Day 9 post-vax I suddenly had an itchy rash at the injection site. No big deal. Just seemed worth mentioning.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-13
-
2021-04-20
Dose 2 — Moderna
- 2021-04-20
-
2021-04-21
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Redness · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-22
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness · Joint painsAdult check-in
- 2021-04-23
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2021-04-24
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Itching · NoneAdult check-in
- 2021-04-25
- 2021-04-26
- 2021-04-27
- 2021-05-04
- 2021-05-11
- 2021-05-18
- 2021-05-25
- 2021-06-01
- 2021-07-20
- 2021-10-19
-
2021-10-22
Dose 3 — Moderna
- 2021-10-29
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2022-01-21
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2022-04-14
Dose 4 — Moderna
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2022-04-15
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain, Redness, Swelling · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-04-16
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Redness, Swelling · HeadacheAdult check-in
-
2022-04-17
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Redness · Headache, Fatigue or tirednessAdult check-in
-
2022-04-18
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Redness, Itching · Fatigue or tirednessAdult check-in
- 2022-04-19
- 2022-04-20
- 2022-04-21
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2022-04-28
Survey response — day 14, dose 4MedDRA: Dizziness, Ear pain, Flushing, Headache, Pain in jaw — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Headaches, dizziness, jaw and ear ache, flushedMedDRA releases: 2024-11 · check-in free text available
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2022-05-05
Survey response — day 21, dose 4MedDRA: Office visit, SARS-CoV-2 test negative, Viral infection — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: Thought I had Covid but after 3 negative home tests and a PCR test turned out to be something else, probably another virus. · Healthcare visit (other): PCR test appointmentMedDRA releases: 2024-11 · check-in free text available
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2022-05-05
Report sent to call center — day 21, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
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2022-05-06
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-05-12
Survey response — day 28, dose 4MedDRA: Hypoaesthesia, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Episodes of numbness in legs and back consistent with MS. Doctor has ordered tests.MedDRA releases: 2024-11 · check-in free text available
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2022-05-12
Report sent to call center — day 28, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-05-13
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-05-19
- 2022-05-26
- 2022-07-14
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2022-09-14
Dose 5 — Moderna
- 2022-09-14
- 2022-09-16
- 2022-09-17
- 2022-09-18
- 2022-09-19
- 2022-09-20
- 2022-09-21
- 2022-09-28
- 2022-10-05
- 2022-10-12
- 2022-10-19
- 2022-10-26
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2022-12-14
Survey response — 3 months, dose 5MedDRA: Bronchitis, Nasopharyngitis, Office visit, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Had a cold Covid negative that turned into bronchitis. · Healthcare visit (other): Saw my primary doctor who diagnosed bronchitis and put me on AdvairMedDRA releases: 2024-11 · check-in free text available
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2022-12-14
Report sent to call center — 3 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2022-12-15
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-03-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-23 | Moderna | |
| 2 | 2021-04-20 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-04-14 | Moderna | No |
| 5 | 2022-09-14 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-05-05 | Successful 2022-05-06 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-05-12 | Successful 2022-05-13 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-12-14 | Successful 2022-12-15 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): Night sweats last night. Getting a good immune response from vax it seems.
Release 7 — day 14, dose 1
Symptoms: Day 9 post-vax I suddenly had an itchy rash at the injection site. No big deal. Just seemed worth mentioning.
Release 11 — day 14, dose 4
Symptoms: Headaches, dizziness, jaw and ear ache, flushed
Release 11 — day 21, dose 4
Symptoms: Thought I had Covid but after 3 negative home tests and a PCR test turned out to be something else, probably another virus.
Healthcare visit (other): PCR test appointment
Release 11 — day 28, dose 4
Symptoms: Episodes of numbness in legs and back consistent with MS. Doctor has ordered tests.
Release 12 — 3 months, dose 5
Symptoms: Had a cold Covid negative that turned into bronchitis.
Healthcare visit (other): Saw my primary doctor who diagnosed bronchitis and put me on Advair
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 | Bronchitis | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Bronchitis | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Ear pain | · | · | ✓ |
| SD | Flushing | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Hypoaesthesia | · | · | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain in jaw | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Viral infection | · | · | ✓ |
| SRO | Night sweats | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release