Z6S-16447-09806
5 vaccinations
7 coded responses
69 check-ins
6 free-text entries
5 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 645 / MO
- Registered
- 2021-02-03
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-03
Registered in v-safe
-
2021-02-03
Dose 1 — Moderna
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-07
- 2021-02-08
- 2021-02-09
- 2021-02-10
- 2021-02-17
- 2021-02-24
-
2021-03-03
Dose 2 — Moderna
- 2021-03-03
-
2021-03-04
Survey response — days 1–6 daily, dose 2MedDRA: Pain — Feeling: Fair · Site: Swelling · Muscle or body achesFree text: I usually have some body aches because of arthritis but this seems more than usual.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-05
- 2021-03-06
- 2021-03-07
-
2021-03-08
Survey response — days 1–6 daily, dose 2MedDRA: Pharyngeal swelling — Feeling: GoodFree text: I had a bit of a swollen throat for about 12 hours last night, but thats gone now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-09
- 2021-03-10
- 2021-03-17
- 2021-03-24
- 2021-03-31
- 2021-04-07
- 2021-04-14
-
2021-06-02
Survey response — 3 months, dose 2MedDRA: Bronchitis, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: I had a cold/mold bronchitis about 2 weeks ago. · Healthcare visit (other): Visit to my primary care physician, prescription for an antibiotic.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-02
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-01
-
2021-10-29
Dose 3 — Moderna
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
-
2022-01-28
Survey response — 3 months, dose 3MedDRA: Bronchitis, Lower respiratory tract infection — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I've had bronchitis and a chest cold (separately)MedDRA releases: 2024-11 · check-in free text available
-
2022-01-28
Report sent to call center — 3 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-01-31
- 2022-04-29
-
2022-05-28
Dose 4 — Moderna
- 2022-05-29
- 2022-05-30
- 2022-05-31
- 2022-06-01
- 2022-06-02
- 2022-06-03
- 2022-06-04
-
2022-06-11
Survey response — day 14, dose 4MedDRA: Nasopharyngitis, Office visit, Oropharyngeal pain, Paranasal sinus hypersecretion, Sinus congestion, Sneezing — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Symptoms: Sinus congestion/drainage, occasional sneezing, slight sore throat, cold symptoms. · Healthcare visit (other): I went to my usual primary care providerMedDRA releases: 2024-11 · check-in free text available
-
2022-06-11
Report sent to call center — day 14, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-06-11
Call successfulParticipant prefers to complete VAERS report online
- 2022-06-13
- 2022-06-13
- 2022-06-13
-
2022-06-13
Call successfulParticipant prefers to complete VAERS report online
-
2022-06-13
Call successfulParticipant prefers to complete VAERS report online
- 2022-06-18
- 2022-06-25
- 2022-07-02
- 2022-07-09
- 2022-08-27
-
2022-11-28
Survey response — 6 months, dose 4MedDRA: Gastrointestinal disorder, Nasopharyngitis, Respiratory tract congestion — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I had a cold with some chest congestion and mild digestive problems 2-3 weeks ago.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-28
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-11-29
-
2022-12-23
Dose 5 — Moderna
- 2022-12-23
- 2022-12-24
- 2022-12-25
- 2022-12-26
- 2022-12-27
- 2022-12-28
- 2022-12-29
- 2022-12-30
-
2023-01-06
Survey response — day 14, dose 5MedDRA: Nasal congestion, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test positive, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationMedDRA releases: 2024-11
-
2023-01-06
Report sent to call center — day 14, dose 5Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2023-01-09
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2023-01-09
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-01-13
- 2023-01-22
- 2023-01-27
- 2023-02-03
- 2023-03-25
- 2023-06-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-03 | Moderna | |
| 2 | 2021-03-03 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-05-28 | Moderna | No |
| 5 | 2022-12-23 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-06-02 | Successful 2022-06-13 |
Participant prefers to complete VAERS report online |
| 2022-01-28 | Successful 2022-06-13 |
Participant prefers to complete VAERS report online |
| 2022-06-11 | Successful 2022-06-11 |
Participant prefers to complete VAERS report online |
| 2022-11-28 | Successful 2023-01-09 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-01-06 | Successful 2023-01-09 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): I usually have some body aches because of arthritis but this seems more than usual.
Systemic reaction (other): I had a bit of a swollen throat for about 12 hours last night, but thats gone now.
Release 8 — 3 months, dose 2
Symptoms: I had a cold/mold bronchitis about 2 weeks ago.
Healthcare visit (other): Visit to my primary care physician, prescription for an antibiotic.
Release 11 — 3 months, dose 3
Symptoms: I've had bronchitis and a chest cold (separately)
Release 12 — day 14, dose 4
Symptoms: Sinus congestion/drainage, occasional sneezing, slight sore throat, cold symptoms.
Healthcare visit (other): I went to my usual primary care provider
Release 12 — 6 months, dose 4
Symptoms: I had a cold with some chest congestion and mild digestive problems 2-3 weeks ago.
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 | Bronchitis | ✓ | ✓ | ✓ |
| SD | Gastrointestinal disorder | · | · | ✓ |
| SD | Lower respiratory tract infection | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Paranasal sinus hypersecretion | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sinus congestion | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pharyngeal swelling | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release