Y95-56963-58668
5 vaccinations
7 coded responses
53 check-ins
7 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 060 / CT
- Registered
- 2020-12-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-30
Registered in v-safe
-
2020-12-30
Dose 1 — Moderna
- 2020-12-30
-
2020-12-31
Survey response — days 1–6 daily, dose 1MedDRA: Cough — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: CoughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-01
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tiredness, NauseaAdult check-in
- 2021-01-02
- 2021-01-03
- 2021-01-04
- 2021-01-05
-
2021-01-06
Survey response — day 7, dose 1MedDRA: Rhinitis — Feeling: GoodFree text: Mild purulent nasal discharge in the AMMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-13
- 2021-01-20
-
2021-01-27
Dose 2 — Moderna
- 2021-01-27
- 2021-01-28
- 2021-01-29
- 2021-01-30
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
- 2021-03-03
-
2021-03-10
Survey response — day 42, dose 2MedDRA: Alopecia areata, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Recently diagnosed with alopecia arreataLikely symptoms started far before vaccinated but diagnosis made only recentlyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-10
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-28
- 2021-07-28
-
2021-10-26
Dose 3 — Moderna
- 2021-10-26
-
2021-10-27
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Joint pains, NauseaAdult check-in
- 2021-10-28
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-09
-
2021-11-16
Survey response — day 21, dose 3MedDRA: Condition aggravated, Pre-existing disease — Feeling: FairFree text: More activity regarding pre existing alipecia aereataMedDRA releases: 2024-11 · check-in free text available
- 2021-11-23
- 2021-11-30
-
2021-12-07
Survey response — day 42, dose 3MedDRA: Alopecia areata, Vitiligo — Feeling: GoodFree text: Slight increase in vitiligo and alopecia aereataMedDRA releases: 2024-11 · check-in free text available
-
2021-12-15
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-01-25
-
2022-04-26
Survey response — 6 months, dose 3MedDRA: Arrhythmia — Feeling: GoodFree text: Short period of arrhythmia. Episode occurred approximately 2 weeks following my last booster dose ( booster # 1). Planned Ny second booster with Novavax when approvedMedDRA releases: 2024-11 · check-in free text available
-
2022-05-02
Dose 4 — Pfizer-BioNTech
- 2022-05-18
- 2022-05-30
- 2022-06-06
- 2022-06-13
-
2022-08-01
Survey response — 3 months, dose 4MedDRA: COVID-19 — 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: COVID 19. Had Paxlovid followed by Paxlovid rebound. Feeling well nowMedDRA releases: 2024-11 · check-in free text available
-
2022-08-01
Report sent to call center — 3 months, 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)
-
2022-08-02
Call successfulNot applicable - Accidental Reporting
-
2022-10-07
Dose 5 — Pfizer-BioNTech
- 2022-10-20
- 2022-10-21
- 2022-10-28
- 2022-11-05
- 2022-11-11
- 2022-11-18
- 2023-01-06
- 2023-04-07
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-30 | Moderna | |
| 2 | 2021-01-27 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
| 4 | 2022-05-02 | Pfizer-BioNTech | No |
| 5 | 2022-10-07 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-10 | Successful 2021-12-15 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-08-01 | Successful 2022-08-02 |
Not applicable - Accidental Reporting |
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Cough
Release 1 — day 7, dose 1
Systemic reaction (other): Mild purulent nasal discharge in the AM
Release 5 — day 42, dose 2
Symptoms: Recently diagnosed with alopecia arreataLikely symptoms started far before vaccinated but diagnosis made only recently
Release 10 — day 21, dose 3
Symptoms: More activity regarding pre existing alipecia aereata
Release 10 — day 42, dose 3
Symptoms: Slight increase in vitiligo and alopecia aereata
Release 11 — 6 months, dose 3
Symptoms: Short period of arrhythmia. Episode occurred approximately 2 weeks following my last booster dose ( booster # 1). Planned Ny second booster with Novavax when approved
Release 12 — 3 months, dose 4
Symptoms: COVID 19. Had Paxlovid followed by Paxlovid rebound. Feeling well now
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 |
|---|---|---|---|---|
| SD | Alopecia areata | ✓ | ✓ | ✓ |
| SD | Arrhythmia | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Vitiligo | · | · | ✓ |
| SRO | Cough | ✓ | ✓ | ✓ |
| SRO | Rhinitis | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release