ZKN-26795-93699
4 vaccinations
10 coded responses
49 check-ins
10 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 208 / MD
- Registered
- 2021-03-31
- Relationship
- Self
- Race
- White
- Ethnicity
- N/A
Timeline
-
2021-03-31
Registered in v-safe
-
2021-03-31
Dose 1 — Janssen/Johnson & Johnson
- 2021-03-31
- 2021-04-01
- 2021-04-02
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-05-05
- 2021-05-12
- 2021-06-30
- 2021-09-29
-
2021-10-27
Dose 2 — Janssen/Johnson & Johnson
- 2021-11-01
-
2021-11-02
Survey response — days 1–6 daily, dose 2MedDRA: No adverse event — Feeling: GoodFree text: NoneMedDRA releases: 2024-11 · check-in free text available
-
2021-11-03
Survey response — day 7, dose 2MedDRA: Abdominal pain, Fatigue, Myalgia, Pain — Feeling: GoodFree text: Shot on Wednesday 10/27. Only (muscle or body aches) and (fatigue or tiredness) and (mild abdominal pain) for the two days following shot Thursday and Friday). Did not affect normal daily activities. Went away Saturday. None since.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2022-01-26
-
2022-04-19
Dose 3 — Moderna
-
2022-04-22
Survey response — days 1–6 daily, dose 3MedDRA: Injection site pain — Feeling: GoodFree text: Ok today. A little soreness in arm where shot was on 20th and 21st.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-23
- 2022-04-24
-
2022-04-25
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
-
2022-04-26
Survey response — day 7, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-05-04
- 2022-05-10
- 2022-05-17
-
2022-06-01
Survey response — day 42, dose 3MedDRA: Cough, Diarrhoea, Fatigue, Paranasal sinus hypersecretion, SARS-CoV-2 test positive, Sinus headache — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Tested Positive for COVID-19 on 19 May 2022 Nasal drainage, persistent cough, sinus headache, fatigue, diarrhea.MedDRA releases: 2024-11 · check-in free text available
- 2022-07-19
-
2022-09-19
Dose 4 — Moderna
- 2022-09-19
-
2022-09-20
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2022-09-21
- 2022-09-22
- 2022-09-23
- 2022-09-24
- 2022-09-25
- 2022-09-26
- 2022-10-03
- 2022-10-10
-
2022-10-19
Survey response — day 28, dose 4MedDRA: Food poisoning, Gastrointestinal viral infection — Feeling: Poor · Be unable to work or attend schoolFree text: GI virus/food poisoningMedDRA releases: 2024-11 · check-in free text available
-
2022-10-24
Survey response — day 35, dose 4MedDRA: Emergency care, Nephrolithiasis — 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 visit, Emergency room or emergency department visit, HospitalizationFree text: Hospital visit and subsequent procedure for kidney stinesMedDRA releases: 2024-11 · check-in free text available
-
2022-10-24
Report sent to call center — day 35, dose 4Be 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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-10-26
-
2022-11-01
Survey response — day 42, dose 4MedDRA: Renal colic — 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 · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visit, HospitalizationFree text: Recovering from kidney stone attack.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-01
Report sent to call center — day 42, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-11-02
- 2022-11-02
-
2022-12-19
Survey response — 3 months, dose 4MedDRA: Nephrolithiasis — Feeling: Good · 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 visit, Emergency room or emergency department visit, HospitalizationFree text: Kidney Stone attachMedDRA releases: 2024-11 · check-in free text available
-
2022-12-19
Report sent to call center — 3 months, dose 4Be 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 · Emergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-12-20
- 2022-12-20
- 2022-12-20
- 2023-03-20
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-31 | Janssen/Johnson & Johnson | |
| 2 | 2021-10-27 | Janssen/Johnson & Johnson | No |
| 3 | 2022-04-19 | Moderna | No |
| 4 | 2022-09-19 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-24 | Unsuccessful | |
| 2022-11-01 | Unsuccessful | |
| 2022-12-19 | Unsuccessful |
Free text
Release 10 — days 1–6 daily, dose 2
Systemic reaction (other): None
Release 10 — day 7, dose 2
Systemic reaction (other): Shot on Wednesday 10/27. Only (muscle or body aches) and (fatigue or tiredness) and (mild abdominal pain) for the two days following shot Thursday and Friday). Did not affect normal daily activities. Went away Saturday. None since.
Release 11 — days 1–6 daily, dose 3
Systemic reaction (other): Ok today. A little soreness in arm where shot was on 20th and 21st.
Systemic reaction (other): No
Release 11 — day 7, dose 3
Systemic reaction (other): No
Release 11 — day 42, dose 3
Symptoms: Tested Positive for COVID-19 on 19 May 2022 Nasal drainage, persistent cough, sinus headache, fatigue, diarrhea.
Release 12 — day 28, dose 4
Symptoms: GI virus/food poisoning
Release 12 — day 35, dose 4
Symptoms: Hospital visit and subsequent procedure for kidney stines
Release 12 — day 42, dose 4
Symptoms: Recovering from kidney stone attack.
Release 12 — 3 months, dose 4
Symptoms: Kidney Stone attach
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 | Cough | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Food poisoning | · | · | ✓ |
| SD | Gastrointestinal viral infection | · | · | ✓ |
| SD | Nephrolithiasis | · | · | ✓ |
| SD | Paranasal sinus hypersecretion | · | · | ✓ |
| SD | Renal colic | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sinus headache | · | · | ✓ |
| SRO | Abdominal pain | · | · | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Myalgia | · | · | ✓ |
| SRO | No adverse event | · | · | ✓ |
| SRO | Pain | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release