Z6R-19810-40132
5 vaccinations
7 coded responses
63 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 466 / IN
- Registered
- 2021-02-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-24
Registered in v-safe
-
2021-02-24
Dose 1 — Moderna
-
2021-02-24
Health check-in — day 0, dose 1Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-11
- 2021-03-17
-
2021-03-24
Dose 2 — Moderna
- 2021-03-24
- 2021-03-25
- 2021-03-26
- 2021-03-28
-
2021-03-29
Survey response — days 1–6 daily, dose 2MedDRA: Oropharyngeal pain — Feeling: FairFree text: Sore throat started yesterday- little better today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-30
- 2021-03-31
- 2021-04-08
- 2021-04-14
-
2021-04-21
Survey response — day 28, dose 2MedDRA: Cough, Dry throat, Retching — Feeling: GoodFree text: Intermittent dry throat coughing to the point where I gag, usually at night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-28
- 2021-05-05
-
2021-06-23
Survey response — 3 months, dose 2MedDRA: Emergency care, Hypotension, Loss of consciousness, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Symptoms: A low blood pressure event, where I passed out and an ambulance took me to the hospital for 26 hrs. There was no smoking gun from blood tests and ekgs.I have felt fine ever since. · Healthcare visit (other): 26 hour surveillanceMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-23
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-29
- 2021-09-22
-
2021-10-28
Dose 3 — Moderna
-
2021-10-29
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-10-30
-
2021-10-31
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Fever · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-11
- 2021-11-18
- 2021-11-25
- 2021-12-02
- 2021-12-09
- 2022-01-27
-
2022-04-16
Dose 4 — Moderna
- 2022-04-19
- 2022-04-20
- 2022-04-21
-
2022-04-22
Survey response — days 1–6 daily, dose 4MedDRA: Unevaluable event — Feeling: Fair · Site: Itching · Fever · Joint painsFree text: Could Hay FeverMedDRA releases: 2024-11 · check-in free text available
- 2022-04-23
-
2022-04-30
Survey response — day 14, dose 4MedDRA: Nasopharyngitis, Pre-existing disease — Feeling: FairFree text: Allergies that led to a cold.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-07
- 2022-05-14
- 2022-05-21
- 2022-05-28
-
2022-07-16
Survey response — 3 months, dose 4MedDRA: Dry throat, Muscle spasms — Feeling: GoodFree text: Leg muscle cramps and dry throat at nightMedDRA releases: 2024-11 · check-in free text available
-
2022-09-23
Dose 5 — ModernaCo-administered: Flu
- 2022-09-23
-
2022-09-24
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-09-25
-
2022-09-26
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Fatigue or tiredness, Nausea, Abdominal painAdult check-in
- 2022-09-27
-
2022-09-28
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2022-09-29
- 2022-10-02
- 2022-10-07
- 2022-10-14
- 2022-10-21
- 2022-10-28
- 2022-11-04
- 2022-12-23
-
2023-03-24
Survey response — 6 months, dose 5MedDRA: Constipation, Gastrointestinal pain, Nausea — Feeling: FairMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-24 | Moderna | |
| 2 | 2021-03-24 | Moderna | |
| 3 | 2021-10-28 | Moderna | No |
| 4 | 2022-04-16 | Moderna | No |
| 5 | 2022-09-23 | Moderna | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-06-23 | Unsuccessful |
Free text
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Sore throat started yesterday- little better today.
Release 7 — day 28, dose 2
Symptoms: Intermittent dry throat coughing to the point where I gag, usually at night.
Release 9 — 3 months, dose 2
Symptoms: A low blood pressure event, where I passed out and an ambulance took me to the hospital for 26 hrs. There was no smoking gun from blood tests and ekgs.I have felt fine ever since.
Healthcare visit (other): 26 hour surveillance
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Could Hay Fever
Release 11 — day 14, dose 4
Symptoms: Allergies that led to a cold.
Release 12 — 3 months, dose 4
Symptoms: Leg muscle cramps and dry throat at night
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 | Constipation | · | · | ✓ |
| SD | Cough | ✓ | ✓ | ✓ |
| SD | Dry throat | ✓ | ✓ | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Gastrointestinal pain | · | · | ✓ |
| SD | Hypotension | ✓ | ✓ | ✓ |
| SD | Loss of consciousness | ✓ | ✓ | ✓ |
| SD | Muscle spasms | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Retching | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release