2JL-22172-54929
2 vaccinations
9 coded responses
26 check-ins
9 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 922 / CA
- Registered
- 2021-03-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-04
Registered in v-safe
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2021-03-04
Dose 1 — Moderna
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2021-03-04
Survey response — day 0, dose 1MedDRA: Unevaluable event — Feeling: GoodFree text: I put down I received Maderna but actually got Pfizer vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-05
Survey response — days 1–6 daily, dose 1MedDRA: Vaccination error — Feeling: Good · Muscle or body achesFree text: I took the Pfizer shot not the Maddrna as I indicated.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-06
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Good · DiarrheaFree text: I took the Pfizer not the Maderna. Mis-input the vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-07
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: GoodFree text: I took the Pfizer shot not the Maderna. My bad.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-08
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: GoodFree text: All is well. Just another reminder for you I mislabeled my vaccine. I actually took the Pfizer vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-09
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: GoodFree text: No issues. Please note I took the Pfizer not the Maderna vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-10
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: GoodFree text: Please note I took the Pfizer vaccine and not the Maderna. My bad.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-11
Survey response — day 7, dose 1MedDRA: Unevaluable event — Feeling: GoodFree text: Everything is okay. I took the Pfzier not Maderna as I stated.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-18
- 2021-03-25
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2021-04-01
Dose 2 — Pfizer-BioNTech
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2021-04-01
Survey response — day 0, dose 2MedDRA: No adverse event — Feeling: Good · Site: PainFree text: No. Took vaccine at 11:00am PST.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-02
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches, Fatigue or tiredness, DiarrheaAdult check-in
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-08
- 2021-04-15
- 2021-04-22
- 2021-04-29
- 2021-05-06
- 2021-05-13
- 2021-07-01
- 2021-09-30
- 2022-04-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-04 | Moderna | |
| 2 | 2021-04-01 | Pfizer-BioNTech |
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): I put down I received Maderna but actually got Pfizer vaccine.
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): I took the Pfizer shot not the Maddrna as I indicated.
Systemic reaction (other): I took the Pfizer not the Maderna. Mis-input the vaccine.
Systemic reaction (other): I took the Pfizer shot not the Maderna. My bad.
Systemic reaction (other): All is well. Just another reminder for you I mislabeled my vaccine. I actually took the Pfizer vaccine.
Systemic reaction (other): No issues. Please note I took the Pfizer not the Maderna vaccine.
Systemic reaction (other): Please note I took the Pfizer vaccine and not the Maderna. My bad.
Release 5 — day 7, dose 1
Systemic reaction (other): Everything is okay. I took the Pfzier not Maderna as I stated.
Release 6 — day 0, dose 2
Systemic reaction (other): No. Took vaccine at 11:00am PST.
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 |
|---|---|---|---|---|
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
| SRO | Vaccination error | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release