ZMV-13264-09905
5 vaccinations
5 coded responses
46 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 334 / FL
- Registered
- 2021-01-29
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-29
Registered in v-safe
-
2021-01-29
Dose 1 — Moderna
- 2021-01-29
-
2021-01-30
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Redness, Itching · Fever · Headache, Muscle or body achesAdult check-in
- 2021-01-31
- 2021-02-01
- 2021-02-02
-
2021-02-03
Health check-in — days 1–6 daily, dose 1Feeling: Good · Fever · Fatigue or tiredness, NauseaAdult check-in
- 2021-02-04
- 2021-02-05
-
2021-02-12
Survey response — day 14, dose 1MedDRA: Injection site pruritus, Injection site rash — Feeling: GoodFree text: Red rash reappeared at injection site along with very mild itching. Now gone again.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-20
-
2021-02-26
Dose 2 — Moderna
- 2021-02-27
-
2021-02-28
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Itching · Headache, NauseaAdult check-in
-
2021-03-01
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Redness, Swelling, Itching · Headache, NauseaAdult check-in
-
2021-03-03
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Itching · Headache, NauseaAdult check-in
- 2021-03-04
- 2021-03-05
- 2021-03-12
- 2021-03-20
- 2021-03-27
- 2021-04-02
- 2021-04-09
- 2021-05-28
-
2021-08-02
Dose 3 — Moderna
- 2021-08-27
-
2021-09-02
Survey response — day 28, dose 3MedDRA: Arthralgia, Chills, Headache — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Have had a headache, aching in both shoulders and chills with NO fearer yesterday after 3rd shot.MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-09-06
Survey response — day 35, dose 3MedDRA: Chills, Fatigue, Headache, Malaise, Pain, Pain in extremity, Pruritus, Rash erythematous — Feeling: Good · Be unable to do your normal daily activitiesFree text: Had headaches, red rash sore left arm, and chill with no temperature son Wednesday. Now some itching rash is gone and I feel fine. Very tired and achy on Wednesday. This is all after 3rd Maderna shot on 8/31/22. Thats 2 days of not feeling greatMedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-09-14
- 2021-11-01
- 2022-02-02
-
2022-04-19
Dose 4 — Moderna
-
2022-04-22
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Swelling · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-04-23
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-04-24
Survey response — days 1–6 daily, dose 4MedDRA: Adverse reaction — Feeling: Good · Site: Pain, Itching · Muscle or body achesFree text: Very mild on both symptomsMedDRA releases: 2024-11 · check-in free text available
- 2022-04-26
- 2022-05-03
- 2022-05-10
- 2022-05-17
- 2022-05-24
- 2022-06-02
- 2022-07-19
-
2022-09-24
Dose 5 — Moderna
- 2022-10-02
- 2022-10-08
- 2022-10-16
- 2022-10-22
- 2022-10-29
- 2022-11-07
- 2022-12-24
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2023-03-25
Survey response — 6 months, dose 5MedDRA: Cough, Nasopharyngitis, Rhinorrhoea, Unevaluable event — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationMedDRA releases: 2024-11
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2023-03-25
Report sent to call center — 6 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2023-03-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-29 | Moderna | |
| 2 | 2021-02-26 | Moderna | |
| 3 | 2021-08-02 | Moderna | No |
| 4 | 2022-04-19 | Moderna | No |
| 5 | 2022-09-24 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2023-03-25 | Unsuccessful |
Free text
Release 4 — day 14, dose 1
Symptoms: Red rash reappeared at injection site along with very mild itching. Now gone again.
Release 9 — day 28, dose 3
Symptoms: Have had a headache, aching in both shoulders and chills with NO fearer yesterday after 3rd shot.
Release 9 — day 35, dose 3
Symptoms: Had headaches, red rash sore left arm, and chill with no temperature son Wednesday. Now some itching rash is gone and I feel fine. Very tired and achy on Wednesday. This is all after 3rd Maderna shot on 8/31/22. Thats 2 days of not feeling great
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Very mild on both symptoms
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 | Arthralgia | ✓ | · | ✓ |
| SD | Chills | ✓ | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Fatigue | ✓ | · | ✓ |
| SD | Headache | ✓ | · | ✓ |
| SD | Injection site pruritus | ✓ | ✓ | ✓ |
| SD | Injection site rash | ✓ | ✓ | ✓ |
| SD | Malaise | ✓ | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Pain | ✓ | · | ✓ |
| SD | Pain in extremity | ✓ | · | ✓ |
| SD | Pruritus | ✓ | · | ✓ |
| SD | Rash erythematous | ✓ | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Adverse reaction | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release