278-20237-47558
5 vaccinations
5 coded responses
54 check-ins
5 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 850 / AZ
- Registered
- 2021-03-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-07
Dose 1 — Moderna
-
2021-03-09
Registered in v-safe
-
2021-03-09
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Joint pains · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-11
Health check-in — days 1–6 daily, dose 1Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-21
- 2021-03-28
-
2021-04-04
Dose 2 — Moderna
-
2021-04-04
Health check-in — day 0, dose 2Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tirednessAdult check-in
-
2021-04-05
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-04-06
Survey response — days 1–6 daily, dose 2MedDRA: Brain fog, Feeling abnormal — Feeling: Fair · Rash, not including the immediate area around the injection siteFree text: Mild brain fogMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-07
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Itching · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-04-08
Health check-in — days 1–6 daily, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-04-09
Health check-in — days 1–6 daily, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
-
2021-04-11
Health check-in — day 7, dose 2Feeling: Good · Rash, not including the immediate area around the injection siteAdult check-in
- 2021-04-19
-
2021-04-25
Survey response — day 21, dose 2MedDRA: Herpes zoster, Office visit, Rash — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Went to see dermatologist for painful rash on right side of scalp that started on 4/18/2021. Was diagnosed with shingles and have been on valacyclovir since 4/22/2021. Will follow up with him on 05/03/2021. · Healthcare visit (other): Normal office visit with dermatologistMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-25
Report sent to call center — day 21, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-02
- 2021-05-09
- 2021-05-16
- 2021-07-04
-
2021-08-20
Dose 3 — Moderna
- 2021-10-03
- 2021-10-03
-
2021-11-19
Survey response — 3 months, dose 3MedDRA: Colitis, Diverticulitis, Nephrolithiasis — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: 4mm Kidney stone, diverticulitis, and pancolitis.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-19
Report sent to call center — 3 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2021-11-22
- 2022-02-19
-
2022-04-15
Dose 4 — Moderna
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2022-04-15
Health check-in — day 0, dose 4Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-04-16
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Joint pains, Muscle or body achesAdult check-in
-
2022-04-17
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Rash, not including the immediate area around the injection siteAdult check-in
-
2022-04-18
Health check-in — days 1–6 daily, dose 4Feeling: Good · Joint pains, Rash, not including the immediate area around the injection siteAdult check-in
- 2022-04-19
- 2022-04-21
- 2022-04-22
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-05-27
-
2022-07-15
Survey response — 3 months, dose 4MedDRA: Herpes zoster, Office visit — Feeling: Poor · Get care from a doctor or other healthcare professionalFree text: Symptoms: Was diagnosed with shingles on left chest, armpit, and shoulderblade · Healthcare visit (other): Priority visit to my dermatologistMedDRA releases: 2024-11 · check-in free text available
-
2022-07-15
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
-
2022-07-18
Call successfulNot applicable - Accidental Reporting
- 2022-10-14
-
2022-11-23
Dose 5 — Moderna
- 2022-11-23
-
2022-11-24
Survey response — days 1–6 daily, dose 5MedDRA: Brain fog — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: A little bit of brain fog this morning. Now its gone.MedDRA releases: 2024-11 · check-in free text available
- 2022-11-25
- 2022-11-26
- 2022-11-27
- 2022-11-28
- 2022-11-29
- 2022-11-30
- 2022-12-07
- 2022-12-14
- 2022-12-23
- 2022-12-30
- 2023-01-04
- 2023-02-22
- 2023-05-24
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-07 | Moderna | |
| 2 | 2021-04-04 | Moderna | |
| 3 | 2021-08-20 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
| 5 | 2022-11-23 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Mild brain fog
Release 7 — day 21, dose 2
Symptoms: Went to see dermatologist for painful rash on right side of scalp that started on 4/18/2021. Was diagnosed with shingles and have been on valacyclovir since 4/22/2021. Will follow up with him on 05/03/2021.
Healthcare visit (other): Normal office visit with dermatologist
Release 10 — 3 months, dose 3
Symptoms: 4mm Kidney stone, diverticulitis, and pancolitis.
Release 12 — 3 months, dose 4
Symptoms: Was diagnosed with shingles on left chest, armpit, and shoulderblade
Healthcare visit (other): Priority visit to my dermatologist
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): A little bit of brain fog this morning. Now its gone.
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 | Colitis | · | · | ✓ |
| SD | Diverticulitis | · | · | ✓ |
| SD | Herpes zoster | ✓ | ✓ | ✓ |
| SD | Nephrolithiasis | · | · | ✓ |
| SD | Rash | ✓ | ✓ | ✓ |
| SRO | Brain fog | · | · | ✓ |
| SRO | Feeling abnormal | ✓ | ✓ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release