27Z-33214-81009
2 vaccinations
2 coded responses
20 check-ins
2 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 531 / WI
- 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
-
2021-01-31
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-05
- 2021-02-13
- 2021-02-19
-
2021-02-24
Dose 2 — Moderna
-
2021-02-26
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-03
- 2021-03-10
- 2021-03-17
- 2021-03-24
- 2021-03-31
- 2021-04-07
-
2021-05-26
Survey response — 3 months, dose 2MedDRA: Ankle operation, Arthropathy, Artificial crown procedure, Dental implantation, Dental restoration failure, Device physical property issue, Fungal skin infection, Office visit, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Ankle problems which will require surgery 6/23/2021. Tooth crown fell off. Dental implant in progress. Fungal rash, currently being treated. No COVID-19 symptoms experienced. · Healthcare visit (other): Doctor visits. 4 different doctors.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-26
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-08-25
Survey response — 6 months, dose 2MedDRA: Foot operation, Office visit, Physiotherapy, Weight bearing difficulty — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationFree text: Symptoms: Surgery to rebuild left foot. Complicated surgery, with long recovery, including one month with no weight bearing. Not caused by an accident. · Healthcare visit (other): Day surgery only, with substantial after visits and physical therapy.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-25
Report sent to call center — 6 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-29 | Moderna | |
| 2 | 2021-02-24 | Moderna |
Call center
2 call center cases
2 unsuccessful
Free text
Release 8 — 3 months, dose 2
Symptoms: Ankle problems which will require surgery 6/23/2021. Tooth crown fell off. Dental implant in progress. Fungal rash, currently being treated. No COVID-19 symptoms experienced.
Healthcare visit (other): Doctor visits. 4 different doctors.
Release 9 — 6 months, dose 2
Symptoms: Surgery to rebuild left foot. Complicated surgery, with long recovery, including one month with no weight bearing. Not caused by an accident.
Healthcare visit (other): Day surgery only, with substantial after visits and physical therapy.
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 | ✓ | ✓ | ✓ |
| HCVO | Physiotherapy | ✓ | · | ✓ |
| SD | Ankle operation | ○ | ✓ | ○ |
| SD | Arthropathy | ✓ | · | ✓ |
| SD | Artificial crown procedure | ○ | ✓ | ○ |
| SD | Dental implantation | ✓ | · | ✓ |
| SD | Dental restoration failure | ✓ | · | ✓ |
| SD | Device physical property issue | ○ | ✓ | ○ |
| SD | Foot operation | ✓ | · | ✓ |
| SD | Fungal skin infection | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ○ | ✓ | ○ |
| SD | Weight bearing difficulty | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release