Z5V-21971-13182
3 vaccinations
5 coded responses
29 check-ins
5 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 242 / VA
- Registered
- 2021-02-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-15
Registered in v-safe
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2021-02-15
Dose 1 — Moderna
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2021-02-15
Health check-in — day 0, dose 1Feeling: Good · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-02-16
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia — Feeling: Good · Site: Pain · HeadacheFree text: Shoulder acheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-17
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-21
- 2021-02-22
- 2021-03-01
- 2021-03-08
- 2021-03-15
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2021-03-16
Dose 2 — Moderna
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-04-01
- 2021-04-06
- 2021-04-13
- 2021-04-22
- 2021-04-27
- 2021-06-15
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2021-09-09
Dose 3 — Moderna
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2021-09-14
Survey response — 6 months, dose 2MedDRA: Arthralgia, Pain in extremity — Feeling: GoodFree text: I got third shot 9-9. Arm and shoulder sore for 3 days better nowMedDRA releases: 2024-11 · check-in free text available
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2021-12-09
Survey response — 3 months, dose 3MedDRA: Cough, Malaise, Pneumonia, Unevaluable event — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Pneumonia cough temperature and generally feeling terribleMedDRA releases: 2024-11 · check-in free text available
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2021-12-09
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
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2021-12-10
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
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2022-03-10
Survey response — 6 months, dose 3MedDRA: Abdominal pain, Cystitis, Immunoglobulin therapy, SARS-CoV-2 test positive, Unevaluable event — Feeling: Fair · 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: Symptoms: 02/05/2022 I received a positive Covid test. I was treated with monoclonal antibody, steroids, inhaler, and 2 different antibiotics. 5 days after treatment I developed acute abdominal pain. I currently being treated for bladder infection. I received · Healthcare visit (other): CT scan, blood, Urine testMedDRA releases: 2024-11 · check-in free text available
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2022-03-10
Report sent to call center — 6 months, 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)
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2022-03-11
Call successfulParticipant prefers to complete VAERS report online
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2022-09-11
Survey response — 12 months, dose 3MedDRA: SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend schoolFree text: Had cov after 2 shots plus booster. Got infusion within 2 hours testing positive. It was a miracle drug. I could feel it healing my bodyMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-15 | Moderna | |
| 2 | 2021-03-16 | Moderna | |
| 3 | 2021-09-09 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-12-09 | Successful 2021-12-10 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-03-10 | Successful 2022-03-11 |
Participant prefers to complete VAERS report online |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Shoulder ache
Release 9 — 6 months, dose 2
Symptoms: I got third shot 9-9. Arm and shoulder sore for 3 days better now
Release 10 — 3 months, dose 3
Symptoms: Pneumonia cough temperature and generally feeling terrible
Release 11 — 6 months, dose 3
Symptoms: 02/05/2022 I received a positive Covid test. I was treated with monoclonal antibody, steroids, inhaler, and 2 different antibiotics. 5 days after treatment I developed acute abdominal pain. I currently being treated for bladder infection. I received cut off by CDC
Healthcare visit (other): CT scan, blood, Urine test
Release 12 — 12 months, dose 3
Symptoms: Had cov after 2 shots plus booster. Got infusion within 2 hours testing positive. It was a miracle drug. I could feel it healing my body
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 | Unevaluable event | · | · | ✓ |
| SD | Abdominal pain | · | · | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Cystitis | · | · | ✓ |
| SD | Immunoglobulin therapy | · | · | ✓ |
| SD | Malaise | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pneumonia | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release