2KT-33104-60062
5 vaccinations
9 coded responses
58 check-ins
8 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 377 / TN
- Registered
- 2021-01-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-15
Registered in v-safe
-
2021-01-15
Dose 1 — Moderna
- 2021-01-15
- 2021-01-16
- 2021-01-18
-
2021-01-20
Survey response — days 1–6 daily, dose 1MedDRA: Exercise tolerance decreased — Feeling: Good · Fatigue or tirednessFree text: My morning run was a little harder than normal. Can't be sure that it was because of the injection.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-24
- 2021-01-29
- 2021-02-05
-
2021-02-12
Dose 2 — Moderna
- 2021-02-12
- 2021-02-13
- 2021-02-14
-
2021-02-15
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Itching · Fatigue or tirednessAdult check-in
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-26
- 2021-03-05
- 2021-03-12
- 2021-03-19
- 2021-03-26
- 2021-05-14
- 2021-08-13
-
2021-08-17
Dose 3 — Moderna
-
2021-08-18
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: Good · Site: Pain, Itching · Headache, Muscle or body aches, Fatigue or tiredness, NauseaFree text: NoMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-19
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: Good · Site: Pain, Itching · Fatigue or tirednessFree text: NoneMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-20
Survey response — days 1–6 daily, dose 3MedDRA: Fatigue — Feeling: Good · Fatigue or tirednessFree text: Hard to be sure on tardis/fatigue, because I'm 76 years old and do a lot of manual work and started my day with a 5 mile run. Show my feeling is tiredness today may not be attributable to the vaccinationMedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-08-21
- 2021-08-22
-
2021-08-23
Survey response — days 1–6 daily, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-24
Survey response — day 7, dose 3MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-08-31
- 2021-09-07
- 2021-09-14
- 2021-09-21
- 2021-09-28
- 2021-11-16
- 2022-02-15
-
2022-04-07
Dose 4 — Moderna
-
2022-04-14
Survey response — day 7, dose 4MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-04-21
- 2022-04-28
- 2022-05-05
- 2022-05-12
- 2022-05-19
- 2022-07-07
-
2022-09-19
Dose 5 — ModernaCo-administered: Flu
- 2022-09-19
-
2022-09-20
Health check-in — days 1–6 daily, dose 5Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2022-09-21
- 2022-09-22
- 2022-09-23
- 2022-09-24
-
2022-09-25
Survey response — days 1–6 daily, dose 5MedDRA: Abdominal pain — Feeling: Good · Abdominal painFree text: I think the abdominal pains came from eating an apple or an empty stomach mid morning. In my opinion probably not associated with the vaccination.MedDRA releases: 2024-11 · check-in free text available
- 2022-09-26
- 2022-10-03
- 2022-10-10
- 2022-10-17
- 2022-10-24
- 2022-10-31
- 2022-12-19
-
2023-03-20
Survey response — 6 months, dose 5MedDRA: Pneumonia, Pneumothorax — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11
-
2023-03-20
Report sent to call center — 6 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2023-03-21
Call successfulDoes not wish to fill out VAERS report
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-15 | Moderna | |
| 2 | 2021-02-12 | Moderna | |
| 3 | 2021-08-17 | Moderna | No |
| 4 | 2022-04-07 | Moderna | No |
| 5 | 2022-09-19 | Moderna | Flu |
Call center
1 call center case
1 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): My morning run was a little harder than normal. Can't be sure that it was because of the injection.
Release 9 — days 1–6 daily, dose 3
Systemic reaction (other): No
Systemic reaction (other): None
Systemic reaction (other): Hard to be sure on tardis/fatigue, because I'm 76 years old and do a lot of manual work and started my day with a 5 mile run. Show my feeling is tiredness today may not be attributable to the vaccination
Systemic reaction (other): No
Release 9 — day 7, dose 3
Systemic reaction (other): No
Release 11 — day 7, dose 4
Systemic reaction (other): No
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): I think the abdominal pains came from eating an apple or an empty stomach mid morning. In my opinion probably not associated with the vaccination.
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 | Pneumonia | · | · | ✓ |
| SD | Pneumothorax | · | · | ✓ |
| SRO | Abdominal pain | · | · | ✓ |
| SRO | Exercise tolerance decreased | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | · | ✓ |
| SRO | No adverse event | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release