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2J8-24240-49963

2 vaccinations 5 coded responses 20 check-ins 5 free-text entries 1 call case
Sex
Male
Age at first dose
66+
ZIP prefix
344 / FL
Registered
2021-02-18
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-02-17
    Dose 1 — Moderna
  2. 2021-02-18
    Registered in v-safe
  3. 2021-02-18
    Survey response — days 1–6 daily, dose 1
    MedDRA: Dizziness — Feeling: Good · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Dizziness within 10 minutes of injection
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-02-19
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Headache
    Adult check-in
  5. 2021-02-20
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  6. 2021-02-21
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-02-22
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-02-26
    Survey response — day 7, dose 1
    MedDRA: Pre-existing disease — Feeling: Good · Fatigue or tiredness
    Free text: I have a mohs surgery scheduled for the 2nd of March and a heart cath on the 8th. I hope all goes well with these procedures.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-03-03
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  10. 2021-03-10
    Survey response — day 21, dose 1
    MedDRA: Pre-existing disease — Feeling: Good
    Free text: Noncovid related heart cath procedure went well with a stent successfully placed on Monday , March 8. Presently Recovering with a new prescription- Brilinta.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-03-17
    Dose 2 — Moderna
  12. 2021-03-20
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  13. 2021-03-22
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-03-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-03-24
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-03-31
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-04-07
    Survey response — day 21, dose 2
    MedDRA: Angina pectoris — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: Noncovid related angina
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-04-07
    Report sent to call center — day 21, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  19. 2021-04-14
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-04-21
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-04-28
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-06-16
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-09-15
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  24. 2022-02-17
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  25. 2022-03-17
    Survey response — 12 months, dose 2
    MedDRA: Angina pectoris, Catheterisation cardiac abnormal, Coronary arterial stent insertion — Feeling: Good · Be unable to do your normal daily activities
    Free text: Persistent Angina that was professionally remedied by the (b)(6) Clinic with a special stent implanted via heart cath
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-02-17Moderna
22021-03-17Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 4 — days 1–6 daily, dose 1

2021-02-18

Systemic reaction (other): Dizziness within 10 minutes of injection

Release 4 — day 7, dose 1

2021-02-26

Systemic reaction (other): I have a mohs surgery scheduled for the 2nd of March and a heart cath on the 8th. I hope all goes well with these procedures.

Release 5 — day 21, dose 1

2021-03-10

Symptoms: Noncovid related heart cath procedure went well with a stent successfully placed on Monday , March 8. Presently Recovering with a new prescription- Brilinta.

Release 7 — day 21, dose 2

2021-04-07

Symptoms: Noncovid related angina

Release 11 — 12 months, dose 2

2022-03-17

Symptoms: Persistent Angina that was professionally remedied by the (b)(6) Clinic with a special stent implanted via heart cath
redacted (b)(6)

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

FieldPreferred term2021-092023-042024-11
SDAngina pectoris ✓ ✓ ✓
SDCatheterisation cardiac abnormal · · ✓
SDCoronary arterial stent insertion · · ✓
SDPre-existing disease ✓ ✓ ✓
SRODizziness ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release