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Y95-23127-63376

2 vaccinations 5 coded responses 14 check-ins 5 free-text entries 2 call cases
Sex
Female
Age at first dose
61-65
ZIP prefix
902 / CA
Registered
2021-02-05
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-05
    Registered in v-safe
  2. 2021-02-05
    Dose 1 — Moderna
  3. 2021-02-05
    Survey response — day 0, dose 1
    MedDRA: Anxiety, Dyspnoea — Feeling: Fair · Fatigue or tiredness
    Free text: shortness of breath, anxiety
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-06
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain, Redness, Swelling · None
    Adult check-in
  5. 2021-02-08
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain, Redness, Swelling · Abdominal pain
    Adult check-in
  6. 2021-02-10
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Redness, Swelling · Fatigue or tiredness
    Adult check-in
  7. 2021-02-14
    Health check-in — day 7, dose 1
    Feeling: Good · Site: Pain, Redness, Swelling · Diarrhea, Abdominal pain
    Adult check-in
  8. 2021-02-21
    Health check-in — day 14, dose 1
    Feeling: Fair
    Adult check-in
  9. 2021-03-05
    Dose 2 — Moderna
  10. 2021-03-12
    Health check-in — day 7, dose 2
    Feeling: Fair · Site: Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  11. 2021-03-19
    Survey response — day 14, dose 2
    MedDRA: Fatigue, Headache — Feeling: Fair · Be unable to do your normal daily activities
    Free text: extremely tired and headache every morning when i get up, then subsides.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-03-28
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  13. 2021-04-06
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-04-10
    Survey response — day 35, dose 2
    MedDRA: Back pain, Fatigue — Feeling: Fair · Be unable to do your normal daily activities
    Free text: extreme fatigue and mid back ache.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-04-19
    Health check-in — day 42, dose 2
    Feeling: Fair
    Adult check-in
  16. 2021-06-04
    Survey response — 3 months, dose 2
    MedDRA: Condition aggravated, Malignant melanoma, Pre-existing disease, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional
    Free text: Symptoms: My HPV that was dormant became active, turned an anal wart before vaccine did not look suspicious and 6 wks after 2nd moderna it now became malignant. · Healthcare visit (other): hematology/ radiation and surgeon
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-06-04
    Report sent to call center — 3 months, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  18. 2022-03-05
    Survey response — 12 months, dose 2
    MedDRA: Cardiac flutter, Palpitations, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: Symptoms: heart ppalpitations and flutters, especially at night while resting or laying on left side. · Healthcare visit (other): also going for a heart consultation with cardiologist
    MedDRA releases: 2024-11 · check-in free text available
  19. 2022-03-05
    Report sent to call center — 12 months, dose 2
    Get care from a doctor or other healthcare professional
    Telehealth, virtual health, or email health consultation · 1 call case(s)
  20. 2022-03-07
    Call successful
    Reported to VAERS voluntarily prior to GDIT contact

Vaccinations

DoseDateManufacturerCo-administered
12021-02-05Moderna
22021-03-05Moderna

Call center

ReportedOutcomeVAERS-related outcome
2021-06-04 Successful Participant prefers to complete VAERS report online
2022-03-05 Successful
2022-03-07
Reported to VAERS voluntarily prior to GDIT contact

Free text

Release 3 — day 0, dose 1

2021-02-05

Systemic reaction (other): shortness of breath, anxiety

Release 5 — day 14, dose 2

2021-03-19

Symptoms: extremely tired and headache every morning when i get up, then subsides.

Release 7 — day 35, dose 2

2021-04-10

Symptoms: extreme fatigue and mid back ache.

Release 8 — 3 months, dose 2

2021-06-04

Symptoms: My HPV that was dormant became active, turned an anal wart before vaccine did not look suspicious and 6 wks after 2nd moderna it now became malignant.
Healthcare visit (other): hematology/ radiation and surgeon

Release 11 — 12 months, dose 2

2022-03-05

Symptoms: heart ppalpitations and flutters, especially at night while resting or laying on left side.
Healthcare visit (other): also going for a heart consultation with cardiologist

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

FieldPreferred term2021-092023-042024-11
HCVOUnevaluable event ✓ ✓ ✓
SDBack pain ✓ ✓ ✓
SDCardiac flutter · · ✓
SDCondition aggravated ✓ ✓ ✓
SDFatigue ✓ ✓ ✓
SDHeadache ✓ ✓ ✓
SDMalignant melanoma ✓ ✓ ✓
SDPalpitations · · ✓
SDPre-existing disease ✓ ✓ ✓
SROAnxiety ✓ ✓ ✓
SRODyspnoea ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release