ZJV-14179-76640
3 vaccinations
8 coded responses
27 check-ins
7 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 0-4
- ZIP prefix
- 501 / IA
- Registered
- 2022-06-20
- Relationship
- Child or adolescent in my care
- Guardian
- 5YD-68713-65746
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2022-06-20
Registered in v-safe
-
2022-06-21
Dose 1 — Moderna
- 2022-06-21
- 2022-06-22
- 2022-06-23
- 2022-06-25
- 2022-06-26
- 2022-06-27
- 2022-06-28
- 2022-07-05
- 2022-07-12
- 2022-07-20
-
2022-07-22
Dose 2 — Moderna
-
2022-07-28
Survey response — days 1–6 daily, dose 2, dependentMedDRA: Chills, Headache, Pain, Pyrexia — Feeling: FairFree text: Fever of 101, headache, slight chills, mild body aches between hours 8-20 post vaccine.MedDRA releases: 2024-11 · check-in free text available
-
2022-07-31
Survey response — day 7, dose 2, dependentMedDRA: Dysphonia — Feeling: FairFree text: Hoarse voice; negative testMedDRA releases: 2024-11 · check-in free text available
- 2022-08-05
- 2022-08-12
-
2022-08-19
Survey response — day 28, dose 2, dependentMedDRA: Cough, Respiratory tract congestion, Sneezing — Feeling: FairFree text: Congestion, sneezing, coughMedDRA releases: 2024-11 · check-in free text available
- 2022-08-28
- 2022-09-02
-
2022-10-18
Dose 3 — Pfizer-BioNTechCo-administered: Flu
- 2022-10-18
-
2022-10-20
Health check-in — days 1–6 daily, dose 3, dependentFeeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitAdult check-in
-
2022-10-20
Report sent to call center — days 1–6 daily, dose 3, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-10-21
- 2022-10-25
-
2022-11-01
Survey response — day 14, dose 3, dependentMedDRA: Adverse reaction, Body temperature increased — Feeling: Fair · Be unable to work or attend schoolFree text: Low grade fever of 99 returned after approximately ten days with resolving symptoms post-booster.MedDRA releases: 2024-11 · check-in free text available
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2022-11-08
Survey response — day 21, dose 3, dependentMedDRA: Ear infection, Pyrexia, Respiratory tract congestion — Feeling: Good · Be unable to work or attend schoolFree text: Congestion, fever / diagnosis of ear infectionMedDRA releases: 2024-11 · check-in free text available
-
2022-11-18
Survey response — day 28, dose 3, dependentMedDRA: Dyspnoea, Fatigue, Heart rate increased, Office visit, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative, Sneezing — Feeling: Poor · Be unable to work or attend school, 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: Fever of 99-102, congestion, tired, sneezing, faster heart rate and shortness of breath during fever spikes. Negative covid and strep by pediatricianMedDRA releases: 2024-11 · check-in free text available
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2022-11-18
Report sent to call center — day 28, dose 3, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-11-21
- 2022-11-21
-
2022-11-22
Survey response — day 35, dose 3, dependentMedDRA: Influenza A virus test positive, Pharyngitis streptococcal, Respiratory syncytial virus infection, SARS-CoV-2 test negative, Sinusitis — Feeling: Fair · Be unable to work or attend school, 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: Tested positive for influenza A and negative for covid, strep, RSV. Required oral dexamethasone and amoxicillin for secondary sinus infection.MedDRA releases: 2024-11 · check-in free text available
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2022-11-22
Report sent to call center — day 35, dose 3, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-11-23
- 2022-11-23
- 2022-11-23
- 2022-12-01
- 2023-01-17
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2023-04-18
Survey response — 6 months, dose 3, dependentMedDRA: Fatigue, Pharyngeal erythema, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Somnolence, Streptococcus test positive — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-04-18
Report sent to call center — 6 months, dose 3, dependentBe unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-04-20
- 2023-04-20
- 2023-04-20
- 2023-04-20
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2022-06-21 | Moderna | No |
| 2 | 2022-07-22 | Moderna | No |
| 3 | 2022-10-18 | Pfizer-BioNTech | Flu |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-20 | Unsuccessful | |
| 2022-11-18 | Unsuccessful | |
| 2022-11-22 | Unsuccessful | |
| 2023-04-18 | Unsuccessful |
Free text
Release 12 — days 1–6 daily, dose 2, dependent
Systemic reaction (other): Fever of 101, headache, slight chills, mild body aches between hours 8-20 post vaccine.
Release 12 — day 7, dose 2, dependent
Systemic reaction (other): Hoarse voice; negative test
Release 12 — day 28, dose 2, dependent
Symptoms: Congestion, sneezing, cough
Release 12 — day 14, dose 3, dependent
Symptoms: Low grade fever of 99 returned after approximately ten days with resolving symptoms post-booster.
Release 12 — day 21, dose 3, dependent
Symptoms: Congestion, fever / diagnosis of ear infection
Release 12 — day 28, dose 3, dependent
Symptoms: Fever of 99-102, congestion, tired, sneezing, faster heart rate and shortness of breath during fever spikes. Negative covid and strep by pediatrician
Release 12 — day 35, dose 3, dependent
Symptoms: Tested positive for influenza A and negative for covid, strep, RSV. Required oral dexamethasone and amoxicillin for secondary sinus infection.
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 | Adverse reaction | · | · | ✓ |
| SD | Body temperature increased | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Ear infection | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Heart rate increased | · | · | ✓ |
| SD | Influenza A virus test positive | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pharyngeal erythema | · | · | ✓ |
| SD | Pharyngitis streptococcal | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Respiratory syncytial virus infection | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sinusitis | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Somnolence | · | · | ✓ |
| SD | Streptococcus test positive | · | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Dysphonia | · | · | ✓ |
| SRO | Headache | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
| SRO | Pyrexia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release