Z2D-12138-70297
2 vaccinations
6 coded responses
26 check-ins
6 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 41-45
- ZIP prefix
- 334 / FL
- Registered
- 2021-04-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-03
Registered in v-safe
-
2021-04-03
Dose 1 — Moderna
- 2021-04-03
- 2021-04-04
-
2021-04-05
Survey response — days 1–6 daily, dose 1MedDRA: Pain — Feeling: Good · Site: PainFree text: The pain decreased since yesterday.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-06
- 2021-04-07
- 2021-04-08
- 2021-04-09
-
2021-04-10
Survey response — day 7, dose 1MedDRA: Headache, Insomnia, Thirst — Feeling: Good · HeadacheFree text: Headache might be associated with thirst or inadequate sleep (lack of sleep likely not due to the vaccine)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-17
- 2021-04-24
-
2021-05-01
Dose 2 — Moderna
- 2021-05-01
-
2021-05-02
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-05-03
Survey response — days 1–6 daily, dose 2MedDRA: Sinus congestion — Feeling: Fair · Site: Pain · Headache, Muscle or body achesFree text: I neglected to mention that I had sinus congestion yesterdayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-04
- 2021-05-05
- 2021-05-06
- 2021-05-07
- 2021-05-08
- 2021-05-15
- 2021-05-22
- 2021-05-29
-
2021-06-05
Survey response — day 35, dose 2MedDRA: Arthralgia, Groin pain, Specialist consultation — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Pain in hip/groin area got worse, but unlikely due to vaccine. · Healthcare visit (other): Seeing pcp. Physical therapy and meds recommendedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-05
Report sent to call center — day 35, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-12
-
2021-07-31
Survey response — 3 months, dose 2MedDRA: Office visit, Pre-existing disease, Sinusitis — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Allergies. Sinus infection · Healthcare visit (other): Doctor visitMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-07-31
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-24
-
2021-09-24
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-11-01
Survey response — 6 months, dose 2MedDRA: Bacterial infection, Hypertension, Office visit, Oropharyngeal pain — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: My blood pressure has been high. I'm working to find the reason for this. I also had what seems to have been a bacterial infection that in part caused a sore throat. · Healthcare visit (other): Doctor's office visitMedDRA releases: 2024-11 · check-in free text available
-
2021-11-01
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-11-10
- 2022-05-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-03 | Moderna | |
| 2 | 2021-05-01 | Moderna |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-06-05 | Successful | Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2021-07-31 | Successful 2021-09-24 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2021-11-01 | Unsuccessful |
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): The pain decreased since yesterday.
Release 7 — day 7, dose 1
Systemic reaction (other): Headache might be associated with thirst or inadequate sleep (lack of sleep likely not due to the vaccine)
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): I neglected to mention that I had sinus congestion yesterday
Release 8 — day 35, dose 2
Symptoms: Pain in hip/groin area got worse, but unlikely due to vaccine.
Healthcare visit (other): Seeing pcp. Physical therapy and meds recommended
Release 9 — 3 months, dose 2
Release 10 — 6 months, dose 2
Symptoms: My blood pressure has been high. I'm working to find the reason for this. I also had what seems to have been a bacterial infection that in part caused a sore throat.
Healthcare visit (other): Doctor's office visit
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 | ✓ | · | ✓ |
| HCVO | Specialist consultation | ✓ | ✓ | ✓ |
| SD | Arthralgia | ✓ | ✓ | ✓ |
| SD | Bacterial infection | · | · | ✓ |
| SD | Groin pain | ✓ | ✓ | ✓ |
| SD | Hypertension | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | ✓ | · | ✓ |
| SD | Sinusitis | ✓ | · | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Sinus congestion | ✓ | ✓ | ✓ |
| SRO | Thirst | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release