Z2A-14034-15589
4 vaccinations
7 coded responses
51 check-ins
7 free-text entries
4 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 970 / OR
- Registered
- 2021-01-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-15
Registered in v-safe
-
2021-01-15
Dose 1 — Moderna
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-21
- 2021-01-22
- 2021-01-29
- 2021-02-05
-
2021-02-11
Dose 2 — Moderna
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-03-11
-
2021-03-18
Survey response — day 35, dose 2MedDRA: Back pain, Office visit — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Lower back pain · Healthcare visit (other): ChiropractorMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-18
Report sent to call center — day 35, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-25
- 2021-05-13
- 2021-08-12
-
2021-10-29
Dose 3 — ModernaCo-administered: Flu
- 2021-10-29
-
2021-10-30
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2022-01-28
- 2022-03-03
-
2022-04-29
Dose 4 — Pfizer-BioNTech
- 2022-04-29
-
2022-04-30
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Headache, Abdominal painAdult check-in
-
2022-05-01
Survey response — days 1–6 daily, dose 4MedDRA: Injection site discomfort — Feeling: Good · Site: PainFree text: My discomfort at the injection site is so minimal that I almost answered no. Because there still is some, I thought I better answer yes.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-02
- 2022-05-03
-
2022-05-04
Survey response — days 1–6 daily, dose 4MedDRA: Depressed mood — Feeling: FairFree text: Just feel somewhat sad.MedDRA releases: 2024-11 · check-in free text available
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2022-05-08
Survey response — day 7, dose 4MedDRA: Cough — Feeling: GoodFree text: I have had a persistent mild cough since getting my shotMedDRA releases: 2024-11 · check-in free text available
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-06-03
-
2022-06-13
Survey response — day 42, dose 4MedDRA: Brain neoplasm malignant, Hepatic cancer, Lung carcinoma cell type unspecified stage IV, Lymphoma — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Diagnosis is stage 4 cancer of brain, lungs, liver, lymph nodes, and maybe stomach and colon.MedDRA releases: 2024-11 · check-in free text available
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2022-06-13
Report sent to call center — day 42, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
-
2022-06-14
Call successfulParticipant prefers to complete VAERS report online
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2022-07-31
Survey response — 3 months, dose 4MedDRA: Lung carcinoma cell type unspecified stage IV, Metastases to central nervous system — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: I have been diagnosed with stage 4 lung cancer that metastasized to the brain.MedDRA releases: 2024-11 · check-in free text available
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2022-07-31
Report sent to call center — 3 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2022-08-01
- 2022-08-01
-
2022-08-02
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-08-02
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-10-28
Survey response — 6 months, dose 4MedDRA: Hepatic enzyme abnormal, Hepatic enzyme decreased, Hepatic enzyme increased — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Was taking Retevmo (120 mgs, twice a day) since mid-August. Liver enzymes rose significantly, so I stopped for 2 weeks. Liver enzymes went down enough, but still not within normal range. Started again at lower dose, 40 mgs twice a day, 9 days agoMedDRA releases: 2024-11 · check-in free text available
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2022-10-28
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-10-31
-
2022-11-10
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-04-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-15 | Moderna | |
| 2 | 2021-02-11 | Moderna | |
| 3 | 2021-10-29 | Moderna | Flu |
| 4 | 2022-04-29 | Pfizer-BioNTech | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-03-18 | Successful 2022-08-02 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-06-13 | Successful 2022-06-14 |
Participant prefers to complete VAERS report online |
| 2022-07-31 | Successful 2022-08-02 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-10-28 | Successful 2022-11-10 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 5 — day 35, dose 2
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): My discomfort at the injection site is so minimal that I almost answered no. Because there still is some, I thought I better answer yes.
Systemic reaction (other): Just feel somewhat sad.
Release 11 — day 7, dose 4
Systemic reaction (other): I have had a persistent mild cough since getting my shot
Release 12 — day 42, dose 4
Symptoms: Diagnosis is stage 4 cancer of brain, lungs, liver, lymph nodes, and maybe stomach and colon.
Release 12 — 3 months, dose 4
Symptoms: I have been diagnosed with stage 4 lung cancer that metastasized to the brain.
Release 12 — 6 months, dose 4
Symptoms: Was taking Retevmo (120 mgs, twice a day) since mid-August. Liver enzymes rose significantly, so I stopped for 2 weeks. Liver enzymes went down enough, but still not within normal range. Started again at lower dose, 40 mgs twice a day, 9 days ago cut off by CDC
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 | Back pain | ✓ | ✓ | ✓ |
| SD | Brain neoplasm malignant | · | · | ✓ |
| SD | Hepatic cancer | · | · | ✓ |
| SD | Hepatic enzyme abnormal | · | · | ✓ |
| SD | Hepatic enzyme decreased | · | · | ✓ |
| SD | Hepatic enzyme increased | · | · | ✓ |
| SD | Lung carcinoma cell type unspecified stage IV | · | · | ✓ |
| SD | Lymphoma | · | · | ✓ |
| SD | Metastases to central nervous system | · | · | ✓ |
| SRO | Cough | · | · | ✓ |
| SRO | Depressed mood | · | · | ✓ |
| SRO | Injection site discomfort | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release