248-11046-88949
4 vaccinations
6 coded responses
24 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 212 / MD
- Registered
- 2021-02-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-02
Dose 1 — Moderna
-
2021-02-21
Registered in v-safe
-
2021-02-21
Survey response — day 14, dose 1MedDRA: Rash, Rash pruritic, Urticaria — Feeling: GoodFree text: 2 days after vaccination, I had urticaria w/rashes in various places on arms, legs, chest + back. Each location would last perhaps a day, and itched enough to cause scratching. Some rashes had welts. After 5 days, rashes ended. Itching much less nowMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-25
-
2021-03-02
Dose 2 — Moderna
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2021-03-03
Survey response — days 1–6 daily, dose 2MedDRA: Disturbance in attention — Feeling: Fair · Site: Pain, Swelling · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to workFree text: Trouble concentratingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-04
Survey response — days 1–6 daily, dose 2MedDRA: Pruritus — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection siteFree text: Itching various places, increasingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-05
- 2021-03-07
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2021-03-08
Health check-in — days 1–6 daily, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2021-03-09
- 2021-03-16
- 2021-03-23
- 2021-03-30
- 2021-04-06
- 2021-04-13
- 2021-06-01
- 2021-08-31
-
2021-11-07
Dose 3 — Moderna
- 2022-03-02
-
2022-04-07
Dose 4 — Moderna
- 2022-04-19
- 2022-04-21
-
2022-04-28
Survey response — day 21, dose 4MedDRA: Limb mass, Neck mass — Feeling: GoodFree text: Some short-lasting mostly macular & some raised lesions on my left ventral forearm for a couple of hours a few days ago, and again on my right ventral neck and superior left shoulder for a couple of hours this morning. Yet this may be food related.MedDRA releases: 2024-11 · check-in free text available
- 2022-05-05
- 2022-05-12
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2022-05-19
Survey response — day 42, dose 4MedDRA: Brain fog, Fatigue, Nasopharyngitis, Oropharyngeal pain — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Tired, mild sore throat, feeling "foggy". Feels like a mile cold. Since yesterday afternoon.MedDRA releases: 2024-11 · check-in free text available
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2022-07-07
Survey response — 3 months, dose 4MedDRA: COVID-19, SARS-CoV-2 test positive, Unevaluable event — 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: I had Covid-19 diagnosed 5/20 by home test and 5/20 by PCR. · Healthcare visit (other): Paxlovid treatmentMedDRA releases: 2024-11 · check-in free text available
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2022-07-07
Report sent to call center — 3 months, dose 4Be 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)
- 2022-07-08
- 2022-10-06
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-02 | Moderna | |
| 2 | 2021-03-02 | Moderna | |
| 3 | 2021-11-07 | Moderna | No |
| 4 | 2022-04-07 | Moderna | No |
Call center
1 call center case
1 unsuccessful
Free text
Release 4 — day 14, dose 1
Symptoms: 2 days after vaccination, I had urticaria w/rashes in various places on arms, legs, chest + back. Each location would last perhaps a day, and itched enough to cause scratching. Some rashes had welts. After 5 days, rashes ended. Itching much less now cut off by CDC
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Trouble concentrating
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Itching various places, increasing
Release 11 — day 21, dose 4
Symptoms: Some short-lasting mostly macular & some raised lesions on my left ventral forearm for a couple of hours a few days ago, and again on my right ventral neck and superior left shoulder for a couple of hours this morning. Yet this may be food related. cut off by CDC
Release 11 — day 42, dose 4
Symptoms: Tired, mild sore throat, feeling "foggy". Feels like a mile cold. Since yesterday afternoon.
Release 12 — 3 months, dose 4
Symptoms: I had Covid-19 diagnosed 5/20 by home test and 5/20 by PCR.
Healthcare visit (other): Paxlovid treatment
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 | Unevaluable event | · | · | ✓ |
| SD | Brain fog | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Limb mass | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Neck mass | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Rash | ✓ | · | ✓ |
| SD | Rash pruritic | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Urticaria | ✓ | ✓ | ✓ |
| SRO | Disturbance in attention | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release