ZG6-11156-00882
5 vaccinations
10 coded responses
59 check-ins
9 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 891 / NV
- Registered
- 2021-02-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
-
2021-02-09
Dose 1 — Moderna
-
2021-02-10
Registered in v-safe
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2021-02-10
Survey response — days 1–6 daily, dose 1MedDRA: Oropharyngeal pain — Feeling: Fair · Site: Pain · HeadacheFree text: Mild sore throatMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-11
- 2021-02-12
- 2021-02-13
-
2021-02-14
Survey response — days 1–6 daily, dose 1MedDRA: Rhinorrhoea — Feeling: GoodFree text: Runny noseMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-15
- 2021-02-16
-
2021-02-23
Survey response — day 14, dose 1MedDRA: Headache, Sinus disorder — Feeling: FairFree text: Headache or simusMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-02
Survey response — day 21, dose 1MedDRA: Abdominal pain upper, Rash, Sinus pain — Feeling: Good · Be unable to do your normal daily activitiesFree text: Had lower stomach pain, sinus pain and a rashOn right lower legMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-09
Dose 2 — Moderna
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2021-03-09
Health check-in — day 0, dose 2Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-03-10
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-11
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Headache, DiarrheaAdult check-in
-
2021-03-12
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness · Headache, DiarrheaAdult check-in
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-04-06
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2021-04-13
Survey response — day 35, dose 2MedDRA: Infection, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Stomach infection- diverticulitisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-20
- 2021-06-08
- 2021-09-07
-
2021-10-22
Dose 3 — Moderna
- 2021-10-26
- 2021-10-27
- 2021-10-28
- 2021-10-29
-
2021-11-05
Survey response — day 14, dose 3MedDRA: Adverse drug reaction, Dizziness, Hospitalisation, Knee arthroplasty, Nausea — Feeling: Poor · Be unable to do your normal daily activitiesFree text: I had knee replacement surgery and still in the hospital. I feel dizzy and nauseous probably due to pain meds.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-12
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2021-11-19
Survey response — day 28, dose 3MedDRA: Knee operation — Feeling: Poor · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Still recovering from knee surgery. Need a unit of bloodMedDRA releases: 2024-11 · check-in free text available
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2021-11-26
Survey response — day 35, dose 3MedDRA: Knee arthroplasty, Nausea — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Still recovering from knee replacement surgery and experience lot of nausea from antibioticsMedDRA releases: 2024-11 · check-in free text available
- 2021-12-03
- 2022-01-21
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2022-04-09
Dose 4 — Moderna
- 2022-04-14
- 2022-04-15
- 2022-04-16
- 2022-04-23
- 2022-04-30
- 2022-05-07
- 2022-05-14
- 2022-05-21
- 2022-07-09
- 2022-10-08
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2022-10-28
Dose 5 — Moderna
- 2022-10-28
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2022-10-29
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2022-10-30
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain · Headache, Joint pains, Muscle or body aches, Diarrhea · Be unable to do your normal daily activitiesAdult check-in
- 2022-10-31
- 2022-11-01
- 2022-11-02
- 2022-11-03
- 2022-11-04
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2022-11-11
Survey response — day 14, dose 5MedDRA: Diverticulitis, Pre-existing disease — Feeling: Fair · 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: Diverticulitis flare upMedDRA releases: 2024-11 · check-in free text available
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2022-11-11
Report sent to call center — day 14, dose 5Be 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)
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2022-11-14
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-18
- 2022-11-25
- 2022-12-02
- 2022-12-09
- 2023-01-29
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2023-04-28
Survey response — 6 months, dose 5MedDRA: Asthma, Diverticulitis — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, HospitalizationMedDRA releases: 2024-11
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2023-04-28
Report sent to call center — 6 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · Hospitalization · 1 call case(s)
- 2023-05-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-09 | Moderna | |
| 2 | 2021-03-09 | Moderna | |
| 3 | 2021-10-22 | Moderna | No |
| 4 | 2022-04-09 | Moderna | No |
| 5 | 2022-10-28 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-11-11 | Successful 2022-11-14 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2023-04-28 | Unsuccessful |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Mild sore throat
Systemic reaction (other): Runny nose
Release 4 — day 14, dose 1
Symptoms: Headache or simus
Release 4 — day 21, dose 1
Symptoms: Had lower stomach pain, sinus pain and a rashOn right lower leg
Release 7 — day 35, dose 2
Symptoms: Stomach infection- diverticulitis
Release 10 — day 14, dose 3
Symptoms: I had knee replacement surgery and still in the hospital. I feel dizzy and nauseous probably due to pain meds.
Release 10 — day 28, dose 3
Symptoms: Still recovering from knee surgery. Need a unit of blood
Release 10 — day 35, dose 3
Symptoms: Still recovering from knee replacement surgery and experience lot of nausea from antibiotics
Release 12 — day 14, dose 5
Symptoms: Diverticulitis flare up
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 |
|---|---|---|---|---|
| SD | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Adverse drug reaction | · | · | ✓ |
| SD | Asthma | · | · | ✓ |
| SD | Diverticulitis | · | · | ✓ |
| SD | Dizziness | · | · | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Infection | ✓ | ✓ | ✓ |
| SD | Knee arthroplasty | · | · | ✓ |
| SD | Knee operation | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SD | Sinus disorder | ✓ | ✓ | ✓ |
| SD | Sinus pain | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release