2S4-23315-25613
3 vaccinations
5 coded responses
30 check-ins
5 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 627 / IL
- Registered
- 2021-01-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-12
Registered in v-safe
-
2021-01-12
Dose 1 — Moderna
- 2021-01-12
-
2021-01-13
Survey response — days 1–6 daily, dose 1MedDRA: Fatigue — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Think just worn out from dealing with two funerals in last three weeks.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
-
2021-01-18
Survey response — days 1–6 daily, dose 1MedDRA: Office visit, Pain, Tooth extraction, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): Had a tooth pulled today so have pain but not related to vaccination · Healthcare visit (other): As previously noted had tooth pulled by oral surgeonMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-18
Report sent to call center — days 1–6 daily, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-01-19
- 2021-01-26
-
2021-02-02
Survey response — day 21, dose 1MedDRA: Abdominal pain upper, Decreased appetite, Mobility decreased, Vertigo — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Woke up 2/1 with mild vertigo and stomach pain. Spent most of day on couch and ate very little. Drank water, tea and zero Gatorade. Went to bed at 6. Much improved and eating lightly today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-09
-
2021-02-11
Dose 2 — Moderna
- 2021-02-23
- 2021-02-25
- 2021-03-04
- 2021-03-11
- 2021-03-18
-
2021-03-18
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-03-25
- 2021-05-13
- 2021-08-12
-
2021-10-26
Dose 3 — Moderna
- 2021-10-26
-
2021-10-27
Survey response — days 1–6 daily, dose 3MedDRA: Headache — Feeling: Good · Site: Pain · Headache, Fatigue or tirednessFree text: Very minor headacheMedDRA releases: 2024-11 · check-in free text available
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — Feeling: Good · Site: Pain · FeverFree text: Temperature is lower than yesterdayMedDRA releases: 2024-11 · check-in free text available
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-09
- 2021-11-16
- 2021-11-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-12 | Moderna | |
| 2 | 2021-02-11 | Moderna | |
| 3 | 2021-10-26 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Think just worn out from dealing with two funerals in last three weeks.
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Had a tooth pulled today so have pain but not related to vaccination
Healthcare visit (other): As previously noted had tooth pulled by oral surgeon
Release 3 — day 21, dose 1
Symptoms: Woke up 2/1 with mild vertigo and stomach pain. Spent most of day on couch and ate very little. Drank water, tea and zero Gatorade. Went to bed at 6. Much improved and eating lightly today.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Very minor headache
Systemic reaction (other): Temperature is lower than yesterday
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 | Tooth extraction | ✓ | · | ✓ |
| HCVO | Unevaluable event | ○ | ✓ | ○ |
| SD | Abdominal pain upper | ✓ | ✓ | ✓ |
| SD | Decreased appetite | ✓ | ✓ | ✓ |
| SD | Mobility decreased | ✓ | ✓ | ✓ |
| SD | Vertigo | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Feeling abnormal | ○ | ○ | ○ |
| SRO | Headache | · | · | ✓ |
| SRO | Pain | ✓ | · | ✓ |
| SRO | Tooth extraction | ✓ | · | ✓ |
| SRO | Unevaluable event | ○ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release