ZTL-57421-46374
5 vaccinations
12 coded responses
45 check-ins
12 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 875 / NM
- Registered
- 2021-02-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-08
Dose 1 — Moderna
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2021-02-09
Registered in v-safe
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2021-02-09
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: Pain, SwellingFree text: Mild tenderness when I touch the injection site, it feels swollen but does not look swollen.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-10
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: GoodFree text: Mild tenderness when I touch the injection site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-11
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: GoodFree text: Mild tenderness when I touch the injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-12
- 2021-02-14
- 2021-02-15
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2021-02-22
Survey response — day 14, dose 1MedDRA: Rhinorrhoea, Sneezing — Feeling: GoodFree text: On the 8th day after my vaccine injection I was sneezing and had a runny nose, it only lasted 1 full day. Since that day I feel fine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-01
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2021-03-08
Dose 2 — Moderna
- 2021-03-08
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2021-03-09
Survey response — days 1–6 daily, dose 2MedDRA: Injection site pain, Injection site swelling — Feeling: Good · Site: Pain, SwellingFree text: The injection site was slightly swollen and painful to touch, and painful when I contracted my deltoid muscle.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-22
- 2021-03-29
- 2021-04-05
- 2021-04-12
- 2021-04-19
- 2021-06-08
- 2021-09-06
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2021-11-05
Dose 3 — Moderna
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2022-04-15
Dose 4 — Moderna
- 2022-04-27
- 2022-04-30
- 2022-05-08
- 2022-05-13
- 2022-05-20
- 2022-05-27
- 2022-07-15
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2022-10-13
Dose 5 — Moderna
- 2022-10-13
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2022-10-14
Health check-in — days 1–6 daily, dose 5Feeling: Poor · Site: Pain, Redness, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2022-10-15
Survey response — days 1–6 daily, dose 5MedDRA: Decreased appetite — Feeling: Poor · Site: Pain, Redness, Swelling · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Loss of apititeMedDRA releases: 2024-11 · check-in free text available
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2022-10-16
Health check-in — days 1–6 daily, dose 5Feeling: Poor · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2022-10-17
Health check-in — days 1–6 daily, dose 5Feeling: Poor · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2022-10-18
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2022-10-19
Health check-in — days 1–6 daily, dose 5Feeling: Poor · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2022-10-20
Survey response — day 7, dose 5MedDRA: Adverse reaction — Feeling: Poor · Chills, Joint pains, Muscle or body aches, Fatigue or tiredness · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: I'm not sure the symptoms I reported the last 2 days are a Covid-19 booster reaction, will have my cardiac consultation tomorrow.MedDRA releases: 2024-11 · check-in free text available
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2022-10-20
Report sent to call center — day 7, dose 5Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
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2022-10-21
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
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2022-10-27
Survey response — day 14, dose 5MedDRA: Cardiac disorder, Dyspnoea, Emergency care, Hypotension, Intensive care, Pneumonia, Troponin — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: 1 week after booster had to go to ER, difficulty breathing, low blood pressure, high troponin level in blood, they thought I was having cardiac problems, sent me to ICU (CCU) wher they diagnosed me with pneumonia, in CCU 4 days, home now, improving sMedDRA releases: 2024-11 · check-in free text available
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2022-10-27
Report sent to call center — day 14, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-10-28
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2022-10-31
Call successfulDoes not wish to fill out VAERS report
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2022-11-03
Survey response — day 21, dose 5MedDRA: Injection site pain, Pain — Feeling: FairFree text: I'm having sporadic sharp pain, it feels like I'm getting an injection, at the site of my last Covid booster on Oct. 13th. It sometimes happens when I'm using my deltoid &/or biceps muscle, but it does not happen every time I'm using those muscles.MedDRA releases: 2024-11 · check-in free text available
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2022-11-11
Survey response — day 28, dose 5MedDRA: Diarrhoea, Feeling abnormal, Gastrointestinal disorder — Feeling: Fair · Be unable to do your normal daily activitiesFree text: I now have developed intestinal issues, diarrhea. I have had abnormal health since my last Covid-19 booster on Oct. 13, related to booster???MedDRA releases: 2024-11 · check-in free text available
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2022-11-20
Survey response — day 35, dose 5MedDRA: Bowel movement irregularity, Gastrointestinal disorder, Hospitalisation — Feeling: Fair · 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 visitFree text: I now have some intestinal issues, abnormal bowel movements, tested negative for c-dyf, think antibiotics while in the hospital caused intestinal problems.MedDRA releases: 2024-11 · check-in free text available
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2022-11-20
Report sent to call center — day 35, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
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2022-11-21
Call successfulParticipant prefers to complete VAERS report online
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2022-11-25
Survey response — day 42, dose 5MedDRA: Faeces soft, Flatulence, Gastrointestinal disorder, Mucous stools — Feeling: Fair · 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: Intestinal issues, producing above normal amount of gas with mucous coming out with the gas and semi soft stool. Have an appointment with my primary care Doctor in 3days. Do not know if this is related to the last Covid-19 booster I received on 10/MedDRA releases: 2024-11 · check-in free text available
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2022-11-25
Report sent to call center — day 42, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-11-28
- 2023-01-13
- 2023-04-14
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-08 | Moderna | |
| 2 | 2021-03-08 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
| 5 | 2022-10-13 | Moderna | No |
Call center
| Reported | Outcome | VAERS-related outcome |
|---|---|---|
| 2022-10-20 | Successful 2022-10-21 |
Not applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill |
| 2022-10-27 | Successful 2022-10-31 |
Does not wish to fill out VAERS report |
| 2022-11-20 | Successful 2022-11-21 |
Participant prefers to complete VAERS report online |
| 2022-11-25 | Unsuccessful |
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): Mild tenderness when I touch the injection site, it feels swollen but does not look swollen.
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Mild tenderness when I touch the injection site.
Systemic reaction (other): Mild tenderness when I touch the injection site
Release 4 — day 14, dose 1
Symptoms: On the 8th day after my vaccine injection I was sneezing and had a runny nose, it only lasted 1 full day. Since that day I feel fine.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): The injection site was slightly swollen and painful to touch, and painful when I contracted my deltoid muscle.
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): Loss of apitite
Release 12 — day 7, dose 5
Healthcare visit (other): I'm not sure the symptoms I reported the last 2 days are a Covid-19 booster reaction, will have my cardiac consultation tomorrow.
Release 12 — day 14, dose 5
Symptoms: 1 week after booster had to go to ER, difficulty breathing, low blood pressure, high troponin level in blood, they thought I was having cardiac problems, sent me to ICU (CCU) wher they diagnosed me with pneumonia, in CCU 4 days, home now, improving s cut off by CDC
Release 12 — day 21, dose 5
Symptoms: I'm having sporadic sharp pain, it feels like I'm getting an injection, at the site of my last Covid booster on Oct. 13th. It sometimes happens when I'm using my deltoid &/or biceps muscle, but it does not happen every time I'm using those muscles. cut off by CDC
Release 12 — day 28, dose 5
Symptoms: I now have developed intestinal issues, diarrhea. I have had abnormal health since my last Covid-19 booster on Oct. 13, related to booster???
Release 12 — day 35, dose 5
Symptoms: I now have some intestinal issues, abnormal bowel movements, tested negative for c-dyf, think antibiotics while in the hospital caused intestinal problems.
Release 12 — day 42, dose 5
Symptoms: Intestinal issues, producing above normal amount of gas with mucous coming out with the gas and semi soft stool. Have an appointment with my primary care Doctor in 3days. Do not know if this is related to the last Covid-19 booster I received on 10/ cut off by CDC
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 | Bowel movement irregularity | · | · | ✓ |
| SD | Cardiac disorder | · | · | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Emergency care | · | · | ✓ |
| SD | Faeces soft | · | · | ✓ |
| SD | Feeling abnormal | · | · | ✓ |
| SD | Flatulence | · | · | ✓ |
| SD | Gastrointestinal disorder | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Hypotension | · | · | ✓ |
| SD | Injection site pain | · | · | ✓ |
| SD | Intensive care | · | · | ✓ |
| SD | Mucous stools | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pneumonia | · | · | ✓ |
| SD | Rhinorrhoea | ✓ | ✓ | ✓ |
| SD | Sneezing | ✓ | ✓ | ✓ |
| SD | Troponin | · | · | ✓ |
| SRO | Decreased appetite | · | · | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Injection site swelling | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release