ZQJ-65503-54461
4 vaccinations
7 coded responses
33 check-ins
7 free-text entries
2 call cases
- Sex
- Female
- Age at first dose
- 66+
- ZIP prefix
- 076 / NJ
- Registered
- 2021-01-22
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-12
Dose 1 — Moderna
-
2021-01-22
Registered in v-safe
- 2021-01-22
- 2021-01-26
- 2021-02-02
-
2021-02-09
Dose 2 — Moderna
- 2021-02-09
-
2021-02-10
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body achesFree text: Not too hungry need to eat toastMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-11
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue — Feeling: Good · Site: PainFree text: Slightly tiredMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-12
- 2021-02-13
- 2021-02-14
-
2021-02-15
Survey response — days 1–6 daily, dose 2MedDRA: Arthritis — Feeling: GoodFree text: Mildly tired but i have arthritis and a back problem which is probably the causesusrMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-16
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-05-11
- 2021-08-10
-
2021-10-19
Dose 3 — Moderna
- 2021-10-26
- 2021-11-02
- 2021-11-09
- 2021-11-16
- 2021-12-02
- 2022-01-18
-
2022-04-13
Dose 4 — Moderna
- 2022-04-18
- 2022-04-19
- 2022-04-20
-
2022-04-27
Survey response — day 14, dose 4MedDRA: Acne, Deafness unilateral, Office visit, Skin cyst excision, Skin papilloma — Feeling: GoodFree text: Small hearing loss in one ear. Wart or other probably benign small pimple on skin removed by dermatologist.MedDRA releases: 2024-11 · check-in free text available
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2022-05-04
Survey response — day 21, dose 4MedDRA: Keratoacanthoma, Office visit, Skin neoplasm excision — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Keratoacanthoma removed no followup required · Healthcare visit (other): Dermatologist officeMedDRA releases: 2024-11 · check-in free text available
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2022-05-04
Report sent to call center — day 21, dose 4Get care from a doctor or other healthcare professional1 call case(s)
-
2022-05-05
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-05-11
Survey response — day 28, dose 4MedDRA: Office visit, Tinnitus — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: More ringing in right ear. Stronger than before. May be due to allergy. · Healthcare visit (other): Doctor visitMedDRA releases: 2024-11 · check-in free text available
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2022-05-11
Report sent to call center — day 28, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-05-12
-
2022-05-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-05-18
- 2022-05-25
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2022-07-13
Survey response — 3 months, dose 4MedDRA: COVID-19, Cough, Nasopharyngitis, Oropharyngeal pain, Pyrexia, Sneezing — Feeling: Good · Be unable to do your normal daily activitiesFree text: Had Covid Omicron, low fever once, terrible sore throat and throat cough. Headcold symptoms, sneezing etc.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-12 | Moderna | |
| 2 | 2021-02-09 | Moderna | |
| 3 | 2021-10-19 | Moderna | No |
| 4 | 2022-04-13 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-05-04 | Successful 2022-05-05 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-05-11 | Successful 2022-05-12 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Not too hungry need to eat toast
Systemic reaction (other): Slightly tired
Systemic reaction (other): Mildly tired but i have arthritis and a back problem which is probably the causesusr
Release 11 — day 14, dose 4
Symptoms: Small hearing loss in one ear. Wart or other probably benign small pimple on skin removed by dermatologist.
Release 11 — day 21, dose 4
Symptoms: Keratoacanthoma removed no followup required
Healthcare visit (other): Dermatologist office
Release 11 — day 28, dose 4
Symptoms: More ringing in right ear. Stronger than before. May be due to allergy.
Healthcare visit (other): Doctor visit
Release 12 — 3 months, dose 4
Symptoms: Had Covid Omicron, low fever once, terrible sore throat and throat cough. Headcold symptoms, sneezing etc.
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 | Office visit | · | · | ✓ |
| SD | Acne | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Deafness unilateral | · | · | ✓ |
| SD | Keratoacanthoma | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Skin cyst excision | · | · | ✓ |
| SD | Skin neoplasm excision | · | · | ✓ |
| SD | Skin papilloma | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Tinnitus | · | · | ✓ |
| SRO | Arthritis | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release