YW3-33583-99365
6 vaccinations
3 coded responses
33 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 851 / AZ
- Registered
- 2021-01-14
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-13
Dose 1 — Moderna
-
2021-01-14
Registered in v-safe
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-22
- 2021-01-28
- 2021-02-03
- 2021-02-10
-
2021-02-17
Dose 2 — Moderna
- 2021-02-25
-
2021-03-03
Survey response — day 14, dose 2MedDRA: Sinusitis — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: I have a sinus infection in my maxillary sinus on the left side however its something that I had had on and off for years so I dont think it really has anything to do with my vaccination.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-03
Report sent to call center — day 14, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-10
- 2021-03-17
- 2021-03-24
- 2021-03-31
- 2021-05-19
- 2021-08-18
-
2021-09-25
Dose 3 — Moderna
- 2021-09-28
- 2021-10-04
-
2021-10-04
Callback requested for3:00PM ET
-
2021-10-04
Call successfulDoes not wish to fill out VAERS report
- 2021-10-25
- 2021-10-31
- 2021-11-06
- 2021-12-25
-
2022-02-17
Dose 4 — Moderna
- 2022-03-26
- 2022-05-20
-
2022-06-06
Dose 5 — Moderna
-
2022-08-18
Survey response — 6 months, dose 4MedDRA: Nasal congestion, Nasopharyngitis, SARS-CoV-2 test negative, Unevaluable event — Feeling: FairFree text: I have a mother of a cold upper respiratory and clogged nose I have already tested myself twice for Covid and they've been negativeMedDRA releases: 2024-11 · check-in free text available
-
2022-09-26
Dose 6 — Moderna
- 2022-10-06
- 2022-10-10
- 2022-10-17
- 2022-10-24
-
2022-10-31
Survey response — day 35, dose 6MedDRA: Office visit, Urinary tract infection — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: A UTI came up in a routine urinalysis. I have not experienced any symptoms at all · Healthcare visit (other): Routine, monthly urology appointmentMedDRA releases: 2024-11 · check-in free text available
-
2022-10-31
Report sent to call center — day 35, dose 6Get care from a doctor or other healthcare professional1 call case(s)
-
2022-11-01
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-08
- 2022-12-26
- 2023-03-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-13 | Moderna | |
| 2 | 2021-02-17 | Moderna | |
| 3 | 2021-09-25 | Moderna | No |
| 4 | 2022-02-17 | Moderna | No |
| 5 | 2022-06-06 | Moderna | No |
| 6 | 2022-09-26 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-03 | Successful 2021-10-04 |
Does not wish to fill out VAERS report |
| 2022-10-31 | Successful 2022-11-01 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 5 — day 14, dose 2
Symptoms: I have a sinus infection in my maxillary sinus on the left side however its something that I had had on and off for years so I dont think it really has anything to do with my vaccination.
Release 12 — 6 months, dose 4
Symptoms: I have a mother of a cold upper respiratory and clogged nose I have already tested myself twice for Covid and they've been negative
Release 12 — day 35, dose 6
Symptoms: A UTI came up in a routine urinalysis. I have not experienced any symptoms at all
Healthcare visit (other): Routine, monthly urology appointment
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 | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Sinusitis | ✓ | ✓ | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SD | Urinary tract infection | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release