Z9T-30977-00420
5 vaccinations
8 coded responses
46 check-ins
8 free-text entries
5 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 360 / AL
- Registered
- 2021-02-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-30
Dose 1 — Moderna
-
2021-02-01
Registered in v-safe
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-13
- 2021-02-20
-
2021-02-27
Dose 2 — Moderna
- 2021-02-27
-
2021-02-28
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: Not sure fatigue due to shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-01
- 2021-03-02
-
2021-03-03
Survey response — days 1–6 daily, dose 2MedDRA: Erythema — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: This is on the same arm but below the injection site. This is also the site of the redness reported yesterdayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-04
Health check-in — days 1–6 daily, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-03-05
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Only small area remainingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-06
- 2021-03-13
- 2021-03-20
- 2021-03-27
-
2021-04-03
Survey response — day 35, dose 2MedDRA: Medical observation, Office visit, Photopsia, Retinal migraine — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Wavy flashes across vision.Doctor diagnosed optic migraine. · Healthcare visit (other): Doctor office visitMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-03
Report sent to call center — day 35, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-10
-
2021-05-29
Survey response — 3 months, dose 2MedDRA: Gastrointestinal bacterial overgrowth, Office visit, Sinusitis, Ulcer — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Sinus and nasal infectionUlcersBacteria in gut · Healthcare visit (other): Doctor's office and hospital outpatient serviceMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-29
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
-
2021-06-14
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-06-14
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2021-08-28
Survey response — 6 months, dose 2MedDRA: Office visit, Ulcer — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Beginning of ulcers · Healthcare visit (other): Doctor office visitMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-28
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-31
-
2021-09-03
Call successfulParticipant prefers to complete VAERS report online
-
2021-11-03
Dose 3 — Moderna
-
2022-02-27
Survey response — 12 months, dose 2MedDRA: Ear pain, Sinus headache, Throat irritation — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Sinus headache, irritated throat, ear painMedDRA releases: 2024-11 · check-in free text available
-
2022-02-27
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-03-01
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-06-15
Dose 4 — Moderna
- 2022-06-24
- 2022-06-29
- 2022-07-06
- 2022-07-13
- 2022-07-20
- 2022-07-27
- 2022-09-19
-
2022-10-12
Dose 5 — Moderna
-
2022-10-12
Health check-in — day 0, dose 5Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-10-13
- 2022-10-14
- 2022-10-15
- 2022-10-16
- 2022-10-17
- 2022-10-18
- 2022-10-19
- 2022-10-26
- 2022-11-04
- 2022-11-09
- 2022-11-16
-
2022-11-23
Survey response — day 42, dose 5MedDRA: Nasal disorder, Office visit, Sinus disorder — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Sinus/nasal issues · Healthcare visit (other): Office appointmentMedDRA releases: 2024-11 · check-in free text available
-
2022-11-23
Report sent to call center — day 42, dose 5Get care from a doctor or other healthcare professional1 call case(s)
-
2022-11-25
Call successfulNot applicable - Accidental Reporting
- 2023-01-11
- 2023-04-12
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-30 | Moderna | |
| 2 | 2021-02-27 | Moderna | |
| 3 | 2021-11-03 | Moderna | No |
| 4 | 2022-06-15 | Moderna | No |
| 5 | 2022-10-12 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-04-03 | Successful 2021-06-14 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2021-05-29 | Successful 2021-06-14 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2021-08-28 | Successful 2021-09-03 |
Participant prefers to complete VAERS report online |
| 2022-02-27 | Successful 2022-03-01 |
Not applicable (accidental reporting or does not believe symptoms are related to vaccine) |
| 2022-11-23 | Successful 2022-11-25 |
Not applicable - Accidental Reporting |
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Not sure fatigue due to shot
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): This is on the same arm but below the injection site. This is also the site of the redness reported yesterday
Systemic reaction (other): Only small area remaining
Release 6 — day 35, dose 2
Symptoms: Wavy flashes across vision.Doctor diagnosed optic migraine.
Healthcare visit (other): Doctor office visit
Release 8 — 3 months, dose 2
Symptoms: Sinus and nasal infectionUlcersBacteria in gut
Healthcare visit (other): Doctor's office and hospital outpatient service
Release 9 — 6 months, dose 2
Release 11 — 12 months, dose 2
Symptoms: Sinus headache, irritated throat, ear pain
Release 12 — day 42, dose 5
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 | Ear pain | · | · | ✓ |
| SD | Gastrointestinal bacterial overgrowth | ✓ | ✓ | ✓ |
| SD | Medical observation | ✓ | ✓ | ✓ |
| SD | Nasal disorder | · | · | ✓ |
| SD | Photopsia | ✓ | ✓ | ✓ |
| SD | Retinal migraine | ✓ | ✓ | ✓ |
| SD | Sinus disorder | · | · | ✓ |
| SD | Sinus headache | · | · | ✓ |
| SD | Sinusitis | ✓ | ✓ | ✓ |
| SD | Throat irritation | · | · | ✓ |
| SD | Ulcer | ✓ | ✓ | ✓ |
| SRO | Erythema | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release