2J9-28232-14860
4 vaccinations
4 coded responses
24 check-ins
4 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 554 / MN
- Registered
- 2021-03-27
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-25
Dose 1 — Moderna
-
2021-03-27
Registered in v-safe
-
2021-03-27
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: Pain · Chills, Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: 100+ degree fever, all of these symptoms were the day after the shot. Today is 2 days post-shot, feeling fine now except mild soreness of injection site. Arm was moderately sore the day after the shot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-28
- 2021-03-29
- 2021-03-31
- 2021-04-01
- 2021-04-08
- 2021-04-17
-
2021-04-22
Dose 2 — Moderna
-
2021-04-22
Survey response — day 0, dose 2MedDRA: Injection site pain — Feeling: Good · Site: Pain · Joint pains, Muscle or body achesFree text: Pain in the left shoulder/upper arm area around the injection site.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-23
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesFree text: Joint pain throughout left shoulder/upper arm from injection. Moving arm is painful.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-24
- 2021-04-25
- 2021-04-26
- 2021-04-27
- 2021-04-28
- 2021-04-29
- 2021-05-06
-
2021-05-13
Survey response — day 21, dose 2MedDRA: Memory impairment — Feeling: GoodFree text: I've not reported this previously, and I have no before or after evidence to place blame, but my memory doesn't seem to be quite what it used to be. There are times where I forget things that should roll right of the end of my tongue.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-20
- 2021-05-27
- 2021-06-03
- 2021-07-22
- 2021-10-23
-
2021-11-17
Dose 3 — Moderna
- 2022-04-22
-
2022-04-25
Dose 4 — Moderna
- 2022-04-30
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-25 | Moderna | |
| 2 | 2021-04-22 | Moderna | |
| 3 | 2021-11-17 | Moderna | No |
| 4 | 2022-04-25 | Moderna | No |
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): 100+ degree fever, all of these symptoms were the day after the shot. Today is 2 days post-shot, feeling fine now except mild soreness of injection site. Arm was moderately sore the day after the shot.
Release 7 — day 0, dose 2
Systemic reaction (other): Pain in the left shoulder/upper arm area around the injection site.
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Joint pain throughout left shoulder/upper arm from injection. Moving arm is painful.
Release 8 — day 21, dose 2
Symptoms: I've not reported this previously, and I have no before or after evidence to place blame, but my memory doesn't seem to be quite what it used to be. There are times where I forget things that should roll right of the end of my tongue.
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 |
|---|---|---|---|---|
| SD | Memory impairment | ✓ | ✓ | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release