Z4R-33968-17602
3 vaccinations
1 coded response
22 check-ins
1 free-text entry
1 call case
- Sex
- Female
- Age at first dose
- 26-30
- ZIP prefix
- 200 / DC
- Registered
- 2021-04-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-08
Dose 1 — Janssen/Johnson & Johnson
-
2021-04-16
Registered in v-safe
- 2021-04-17
- 2021-04-24
- 2021-04-29
- 2021-05-06
- 2021-05-13
- 2021-05-20
-
2021-07-08
Survey response — 3 months, dose 1MedDRA: Concussion, Dehydration, Syncope — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Concussion, fainting, dehydrationMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-07-08
Report sent to call center — 3 months, dose 1Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
-
2021-07-12
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-10-07
-
2021-11-04
Dose 2 — Moderna
-
2022-04-05
Dose 3 — Moderna
-
2022-04-05
Health check-in — day 0, dose 3Feeling: Good · None · Be unable to do your normal daily activitiesAdult check-in
-
2022-04-06
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Fever · Chills, Headache, Fatigue or tiredness, Abdominal pain · Be unable to work or attend schoolAdult check-in
- 2022-04-07
- 2022-04-08
- 2022-04-09
- 2022-04-10
- 2022-04-11
- 2022-04-14
- 2022-04-19
- 2022-04-26
- 2022-05-03
- 2022-05-10
- 2022-05-17
- 2023-04-05
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-08 | Janssen/Johnson & Johnson | |
| 2 | 2021-11-04 | Moderna | No |
| 3 | 2022-04-05 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-07-08 | Successful 2021-07-12 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
Free text
Release 9 — 3 months, dose 1
Symptoms: Concussion, fainting, dehydration
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 |
|---|---|---|---|---|
| SD | Concussion | ✓ | ✓ | ✓ |
| SD | Dehydration | ✓ | ✓ | ✓ |
| SD | Syncope | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release