ZA9-20986-98481
4 vaccinations
8 coded responses
47 check-ins
8 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 210 / MD
- Registered
- 2021-02-19
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-18
Dose 1 — Moderna
-
2021-02-19
Registered in v-safe
-
2021-02-19
Survey response — days 1–6 daily, dose 1MedDRA: Lethargy — Feeling: GoodFree text: I felt a little lethargic yesterday afternoon for about 15 -20 minutes.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-20
-
2021-02-21
Survey response — days 1–6 daily, dose 1MedDRA: Heart rate increased — Feeling: Fair · Fatigue or tirednessFree text: My heard rate is a little above normal todayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-22
- 2021-02-23
- 2021-02-24
- 2021-02-25
- 2021-03-04
- 2021-03-11
-
2021-03-18
Dose 2 — Moderna
-
2021-03-18
Survey response — day 0, dose 2MedDRA: Dizziness — Feeling: Fair · Site: PainFree text: Slightly light headedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-22
-
2021-03-23
Survey response — days 1–6 daily, dose 2MedDRA: Hypersensitivity, Pre-existing disease, Sinus headache — Feeling: Fair · Headache · Be unable to do your normal daily activitiesFree text: Having simus headaches & suffering from season al allergies.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-24
Survey response — days 1–6 daily, dose 2MedDRA: Headache, Office visit, Pre-existing disease, Sinusitis — Feeling: Good · HeadacheFree text: Initially had a nagging headache today in the last few days. However, Dr. diagnosed it as a mild sinus infection due to seasonal pollen in the air in this region.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-26
- 2021-04-01
- 2021-04-08
- 2021-04-15
- 2021-04-22
- 2021-04-29
- 2021-06-17
- 2021-09-16
-
2021-10-30
Dose 3 — Moderna
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-04
- 2021-11-05
- 2021-11-06
- 2021-11-13
- 2021-11-20
- 2021-11-27
- 2021-12-04
- 2021-12-12
-
2022-01-29
Survey response — 3 months, dose 3MedDRA: Arthritis, Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Reoccurring issues with my back and knees associated with arthritis. · Healthcare visit (other): Office visitMedDRA releases: 2024-11 · check-in free text available
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2022-01-29
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professional1 call case(s)
-
2022-04-01
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-04-13
Dose 4 — Moderna
- 2022-04-19
- 2022-04-20
- 2022-04-27
- 2022-05-04
- 2022-05-11
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2022-05-18
Survey response — day 35, dose 4MedDRA: Laboratory test abnormal, Lacrimation increased, Sneezing — Feeling: FairFree text: I started a lot of sneezing and Teria eyes on Sunday evening and has stayed with me since today. I decided to take a home test and have tested positive twice today. Speaking with my doctor tomorrow .MedDRA releases: 2024-11 · check-in free text available
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2022-05-25
Survey response — day 42, dose 4MedDRA: Cough, Discharge, SARS-CoV-2 test positive, Sneezing — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: On May 15, I started having what I thought were seasonal allergies with sneezing lots of drip and some coughing. I gave myself at home Covid test on May 18 & tested positive for COVID 19.MedDRA releases: 2024-11 · check-in free text available
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2022-05-25
Report sent to call center — day 42, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
-
2022-05-26
Call successfulDoes not wish to fill out VAERS report
- 2022-07-13
- 2022-10-12
- 2023-04-14
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-18 | Moderna | |
| 2 | 2021-03-18 | Moderna | |
| 3 | 2021-10-30 | Moderna | No |
| 4 | 2022-04-13 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-01-29 | Successful 2022-04-01 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-05-25 | Successful 2022-05-26 |
Does not wish to fill out VAERS report |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): I felt a little lethargic yesterday afternoon for about 15 -20 minutes.
Systemic reaction (other): My heard rate is a little above normal today
Release 5 — day 0, dose 2
Systemic reaction (other): Slightly light headed
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Having simus headaches & suffering from season al allergies.
Systemic reaction (other): Initially had a nagging headache today in the last few days. However, Dr. diagnosed it as a mild sinus infection due to seasonal pollen in the air in this region.
Release 11 — 3 months, dose 3
Symptoms: Reoccurring issues with my back and knees associated with arthritis.
Healthcare visit (other): Office visit
Release 11 — day 35, dose 4
Symptoms: I started a lot of sneezing and Teria eyes on Sunday evening and has stayed with me since today. I decided to take a home test and have tested positive twice today. Speaking with my doctor tomorrow .
Release 11 — day 42, dose 4
Symptoms: On May 15, I started having what I thought were seasonal allergies with sneezing lots of drip and some coughing. I gave myself at home Covid test on May 18 & tested positive for COVID 19.
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 | Arthritis | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Discharge | · | · | ✓ |
| SD | Laboratory test abnormal | · | · | ✓ |
| SD | Lacrimation increased | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Heart rate increased | ✓ | ✓ | ✓ |
| SRO | Hypersensitivity | ✓ | ✓ | ✓ |
| SRO | Lethargy | ✓ | ✓ | ✓ |
| SRO | Office visit | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Sinus headache | ✓ | ✓ | ✓ |
| SRO | Sinusitis | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release