Z4N-10234-79505
4 vaccinations
7 coded responses
38 check-ins
7 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 26-30
- ZIP prefix
- 926 / CA
- Registered
- 2021-01-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-24
Registered in v-safe
-
2021-01-24
Dose 1 — Moderna
- 2021-01-24
- 2021-01-25
-
2021-01-26
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-01-27
- 2021-01-29
- 2021-01-30
- 2021-02-02
- 2021-02-07
- 2021-02-14
- 2021-02-21
-
2021-02-26
Dose 2 — Moderna
- 2021-02-26
-
2021-02-27
Survey response — days 1–6 daily, dose 2MedDRA: Chills — Feeling: Poor · Site: Pain · Fever · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to workFree text: Involuntary shivering. Not "chills" because I didn't feel cold, just shivering that started in the arm where the shot was, and traveled up to my lower jaw.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-28
Health check-in — days 1–6 daily, dose 2Feeling: Good · Headache, Fatigue or tirednessAdult check-in
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-12
- 2021-03-19
- 2021-03-26
-
2021-04-02
Survey response — day 35, dose 2MedDRA: Asthma, Cough, Dehydration — Feeling: GoodFree text: I've had a mild cough for the past week, but I have asthma and was not drinking enough water so I'm not seeing this as vaccine-relatedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-09
Survey response — day 42, dose 2MedDRA: Anxiety — Feeling: PoorFree text: Feeling anxiety intensely, not sure it has anything to do with the vaccine though.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-28
- 2021-08-27
-
2021-11-21
Dose 3 — Moderna
-
2021-12-03
Health check-in — day 7, dose 3Feeling: Poor · Fatigue or tiredness, Rash, not including the immediate area around the injection site · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitAdult check-in
-
2021-12-03
Report sent to call center — day 7, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-12-05
- 2021-12-09
- 2021-12-12
- 2021-12-19
- 2021-12-26
-
2022-01-02
Survey response — day 42, dose 3MedDRA: Cough, Oropharyngeal pain, SARS-CoV-2 test positive, Sneezing — Feeling: Fair · Be unable to work or attend schoolFree text: December 29th, 2021 mild sore throat. December 30th, the sore throat worse. December 31st, received a positive COVID PCR result. Sore throat, mild cough, occasional sneezing, most likely due to COVID. January 2nd, most symptoms gone.MedDRA releases: 2024-11 · check-in free text available
-
2022-02-20
Survey response — 3 months, dose 3MedDRA: Eczema, Mechanical urticaria, Office visit — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Dermatographic Urticaria, Eczema · Healthcare visit (other): In person visit to Dermatologist officeMedDRA releases: 2024-11 · check-in free text available
-
2022-02-20
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-02-21
-
2022-03-22
Call successfulParticipant prefers to complete VAERS report online
- 2022-05-22
-
2022-10-15
Dose 4 — Moderna
-
2022-11-21
Survey response — day 35, dose 4MedDRA: Asthma, Cough, Pre-existing disease — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Dry cough lasting more than 4 weeks, likely made worse by my asthma.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-21
Survey response — 12 months, dose 3MedDRA: Cough, Influenza virus test negative, Pre-existing disease, SARS-CoV-2 test negative — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: Cough that won't go away, although this is likely related to my asthma. Took a COVID, Flu A, Flu B, and RSV test, came back negative for all.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-21
Report sent to call center — 12 months, dose 3Be unable to work or attend school · 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)
-
2022-11-21
Report sent to call center — day 35, dose 4Be unable to work or attend school · 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)
- 2022-11-22
- 2022-11-22
- 2022-11-26
- 2023-01-14
- 2023-04-17
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-24 | Moderna | |
| 2 | 2021-02-26 | Moderna | |
| 3 | 2021-11-21 | Moderna | No |
| 4 | 2022-10-15 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-12-03 | Successful | Participant prefers to complete VAERS report online |
| 2022-02-20 | Successful 2022-03-22 |
Participant prefers to complete VAERS report online |
| 2022-11-21 | Unsuccessful | |
| 2022-11-21 | Unsuccessful |
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Involuntary shivering. Not "chills" because I didn't feel cold, just shivering that started in the arm where the shot was, and traveled up to my lower jaw.
Release 6 — day 35, dose 2
Symptoms: I've had a mild cough for the past week, but I have asthma and was not drinking enough water so I'm not seeing this as vaccine-related
Release 7 — day 42, dose 2
Symptoms: Feeling anxiety intensely, not sure it has anything to do with the vaccine though.
Release 10 — day 42, dose 3
Symptoms: December 29th, 2021 mild sore throat. December 30th, the sore throat worse. December 31st, received a positive COVID PCR result. Sore throat, mild cough, occasional sneezing, most likely due to COVID. January 2nd, most symptoms gone.
Release 11 — 3 months, dose 3
Symptoms: Dermatographic Urticaria, Eczema
Healthcare visit (other): In person visit to Dermatologist office
Release 12 — 12 months, dose 3
Symptoms: Cough that won't go away, although this is likely related to my asthma. Took a COVID, Flu A, Flu B, and RSV test, came back negative for all.
Release 12 — day 35, dose 4
Symptoms: Dry cough lasting more than 4 weeks, likely made worse by my asthma.
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 | Anxiety | ✓ | ✓ | ✓ |
| SD | Asthma | ✓ | ✓ | ✓ |
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Dehydration | ✓ | ✓ | ✓ |
| SD | Eczema | · | · | ✓ |
| SD | Influenza virus test negative | · | · | ✓ |
| SD | Mechanical urticaria | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release