Z3D-32216-85643
5 vaccinations
7 coded responses
51 check-ins
7 free-text entries
3 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 778 / TX
- Registered
- 2021-02-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-01
Registered in v-safe
-
2021-02-01
Dose 1 — Moderna
- 2021-02-01
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-15
- 2021-02-22
- 2021-03-01
-
2021-03-04
Dose 2 — Moderna
- 2021-03-08
- 2021-03-09
- 2021-03-11
- 2021-03-18
- 2021-03-25
- 2021-04-02
- 2021-04-08
-
2021-04-15
Survey response — day 42, dose 2MedDRA: Abdominal pain upper, Diarrhoea — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree text: Diarrhea for a few days, with stomach painsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-06-03
- 2021-09-02
-
2021-10-23
Dose 3 — Moderna
-
2021-10-26
Survey response — days 1–6 daily, dose 3MedDRA: Chills, Erythema, Fatigue, Headache, Myalgia, Nausea, Pain — Feeling: Good · Site: RednessFree text: Symptoms began 12 hours after inoculation on 10/23/21: chills, headache, muscle body aches, fatigue, nausea; they subsided yesterday but redness on the arm just manifested today, 3 days after the booster shot.MedDRA releases: 2024-11 · check-in free text available
-
2021-10-27
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — Feeling: Fair · Site: Redness, Swelling, Itching · Chills, Fatigue or tiredness, Nausea · 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: Recommendations of Allergra & cool compress to injection siteMedDRA releases: 2024-11 · check-in free text available
-
2021-10-27
Report sent to call center — days 1–6 daily, dose 3Be 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)
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — Feeling: Good · Site: Itching · Rash, not including the immediate area around the injection siteFree text: Day 5 has been best yet!MedDRA releases: 2024-11 · check-in free text available
- 2021-10-29
-
2021-10-30
Survey response — day 7, dose 3MedDRA: Ear discomfort — Feeling: Good · Site: ItchingFree text: Ear: pressure, airplane modeMedDRA releases: 2024-11 · check-in free text available
-
2021-11-01
Call successfulParticipant prefers to complete VAERS report online
- 2021-11-06
- 2021-11-13
- 2021-11-20
- 2021-11-27
- 2021-12-04
- 2022-01-22
- 2022-04-23
-
2022-04-29
Dose 4 — Moderna
-
2022-05-15
Survey response — day 14, dose 4MedDRA: Adverse reaction, Ear pain, Office visit — 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 consultation, Outpatient clinic or urgent care clinic visitFree text: Symptoms: Recovery after vaccination took 5-6 days. I experienced multiple symptoms. Yesterday and today I developed ear ache. · Healthcare visit (other): I notified the provider of the vaccine and my physicians during appointments for other issues.MedDRA releases: 2024-11 · check-in free text available
-
2022-05-15
Report sent to call center — day 14, dose 4Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-05-17
- 2022-05-20
- 2022-05-27
- 2022-06-03
-
2022-06-10
Survey response — day 42, dose 4MedDRA: Lung disorder, Ultrasound breast abnormal, Urogenital disorder — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Abnormal ABUS results for the first time. Urogenital symptoms and treatment. Pulmonary illness.MedDRA releases: 2024-11 · check-in free text available
-
2022-06-10
Report sent to call center — day 42, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-06-13
Call successfulDoes not wish to fill out VAERS report
-
2022-09-29
Dose 5 — Pfizer-BioNTechCo-administered: Flu
- 2022-09-29
- 2022-09-30
- 2022-10-01
- 2022-10-02
- 2022-10-03
- 2022-10-04
- 2022-10-05
- 2022-10-06
- 2022-10-13
- 2022-10-20
- 2022-10-27
- 2022-11-03
- 2022-11-10
- 2022-12-29
- 2023-03-30
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-01 | Moderna | |
| 2 | 2021-03-04 | Moderna | |
| 3 | 2021-10-23 | Moderna | No |
| 4 | 2022-04-29 | Moderna | No |
| 5 | 2022-09-29 | Pfizer-BioNTech | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-10-27 | Successful 2021-11-01 |
Participant prefers to complete VAERS report online |
| 2022-05-15 | Successful | Does not wish to fill out VAERS report |
| 2022-06-10 | Successful 2022-06-13 |
Does not wish to fill out VAERS report |
Free text
Release 7 — day 42, dose 2
Symptoms: Diarrhea for a few days, with stomach pains
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Symptoms began 12 hours after inoculation on 10/23/21: chills, headache, muscle body aches, fatigue, nausea; they subsided yesterday but redness on the arm just manifested today, 3 days after the booster shot.
Healthcare visit (other): Recommendations of Allergra & cool compress to injection site
Systemic reaction (other): Day 5 has been best yet!
Release 10 — day 7, dose 3
Systemic reaction (other): Ear: pressure, airplane mode
Release 11 — day 14, dose 4
Symptoms: Recovery after vaccination took 5-6 days. I experienced multiple symptoms. Yesterday and today I developed ear ache.
Healthcare visit (other): I notified the provider of the vaccine and my physicians during appointments for other issues.
Release 12 — day 42, dose 4
Symptoms: Abnormal ABUS results for the first time. Urogenital symptoms and treatment. Pulmonary illness.
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 | Unevaluable event | · | · | ✓ |
| SD | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Adverse reaction | · | · | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Ear pain | · | · | ✓ |
| SD | Lung disorder | · | · | ✓ |
| SD | Ultrasound breast abnormal | · | · | ✓ |
| SD | Urogenital disorder | · | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Ear discomfort | · | · | ✓ |
| SRO | Erythema | · | · | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Myalgia | · | · | ✓ |
| SRO | Nausea | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release