ZLA-16572-09290
3 vaccinations
7 coded responses
26 check-ins
7 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 980 / WA
- Registered
- 2021-01-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-15
Dose 1 — Moderna
-
2021-01-16
Registered in v-safe
- 2021-01-16
-
2021-01-17
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: GoodFree text: No issues what so ever besides a little tenderness at injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-18
- 2021-01-19
-
2021-01-21
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: Good · HeadacheFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-22
- 2021-01-29
- 2021-02-05
-
2021-02-10
Dose 2 — Moderna
-
2021-02-11
Survey response — days 1–6 daily, dose 2MedDRA: Musculoskeletal stiffness — Feeling: Good · Site: Pain · Muscle or body achesFree text: Injection site area has been stiff, but still usableMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-12
Survey response — days 1–6 daily, dose 2MedDRA: Chills, Injection site pain — Feeling: Good · Fever · ChillsFree text: Very mild Soreness around site but nothing else except chills, but its also very cold weather so that could be contributing to chillsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-13
Survey response — days 1–6 daily, dose 2MedDRA: Injection site erythema, Injection site swelling, Injection site warmth — Feeling: Good · Site: Pain, Redness, SwellingFree text: Arm area around injection site is warm, red and slightly swollen.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-14
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Redness, Swelling · HeadacheAdult check-in
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-24
- 2021-03-03
- 2021-03-10
- 2021-03-19
- 2021-03-26
- 2021-05-14
-
2021-08-14
Survey response — 6 months, dose 2MedDRA: Adverse reaction, Dyspnoea exertional, Office visit — Feeling: Good · 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: Symptoms: Shortness of breath while physical exersion, i.e. fast or uphill walking or constant bending over. This started about a month after my first shot in jan. 2021. At first i thought it was chest pain, went in to dr asap. Many tests clear heart lung prob · Healthcare visit (other): Still having this issue, but it has improved slightly.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-14
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-11-11
Dose 3 — Moderna
- 2021-12-09
- 2022-02-10
- 2022-02-12
- 2022-05-15
-
2022-11-11
Survey response — 12 months, dose 3MedDRA: Nasopharyngitis, Oropharyngeal pain, Sinus congestion — Feeling: FairFree text: Common cold,sore throat, full sinusesMedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-15 | Moderna | |
| 2 | 2021-02-10 | Moderna | |
| 3 | 2021-11-11 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2021-08-14 | Unsuccessful |
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): No issues what so ever besides a little tenderness at injection site
Systemic reaction (other): No
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Injection site area has been stiff, but still usable
Systemic reaction (other): Very mild Soreness around site but nothing else except chills, but its also very cold weather so that could be contributing to chills
Systemic reaction (other): Arm area around injection site is warm, red and slightly swollen.
Release 9 — 6 months, dose 2
Symptoms: Shortness of breath while physical exersion, i.e. fast or uphill walking or constant bending over. This started about a month after my first shot in jan. 2021. At first i thought it was chest pain, went in to dr asap. Many tests clear heart lung prob cut off by CDC
Healthcare visit (other): Still having this issue, but it has improved slightly.
Release 12 — 12 months, dose 3
Symptoms: Common cold,sore throat, full sinuses
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 | Adverse reaction | ✓ | · | ✓ |
| SD | Dyspnoea exertional | ✓ | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Office visit | ✓ | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Sinus congestion | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Injection site swelling | ✓ | ✓ | ✓ |
| SRO | Injection site warmth | ✓ | ✓ | ✓ |
| SRO | Musculoskeletal stiffness | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release