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2TP-16501-22550

4 vaccinations 6 coded responses 12 check-ins 6 free-text entries 0 call cases
Sex
Male
Age at first dose
56-60
ZIP prefix
112 / NY
Registered
2021-02-04
Relationship
Self
Race
N/A
Ethnicity
N/A

Timeline

  1. 2021-02-04
    Registered in v-safe
  2. 2021-02-04
    Dose 1 — Moderna
  3. 2021-02-04
    Health check-in — day 0, dose 1
    Feeling: Fair · Site: Pain, Swelling · Headache
    Adult check-in
  4. 2021-02-06
    Survey response — days 1–6 daily, dose 1
    MedDRA: Chills, Cough, Decreased appetite, Headache — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache · Be unable to work, Be unable to do your normal daily activities
    Free text: Headache for 3 days(worst part)-severe chills at sleep(2days)-light cough-lack of appetite
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-02-07
    Survey response — days 1–6 daily, dose 1
    MedDRA: Cough, Decreased appetite, Frequent bowel movements, Headache — Feeling: Poor · Site: Pain, Swelling · Headache, Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Lack of appetite, defecating more, continued headache, slight cough.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-02-08
    Survey response — days 1–6 daily, dose 1
    MedDRA: Cough, Rhinorrhoea — Feeling: Good · Site: Pain, Swelling
    Free text: Slight cough, runny nose(a little).
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-02-09
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain, Swelling · None
    Adult check-in
  8. 2021-02-10
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Swelling · None
    Adult check-in
  9. 2021-03-04
    Dose 2 — Moderna
  10. 2021-08-05
    Health check-in — 6 months, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-11-30
    Dose 3 — Moderna
  12. 2022-02-04
    Health check-in — 12 months, dose 1
    Feeling: Good
    Adult check-in
  13. 2022-06-22
    Dose 4 — Moderna
  14. 2022-06-24
    Survey response — days 1–6 daily, dose 4
    MedDRA: Axillary pain, Dizziness, Pain in extremity, Sleep disorder — Feeling: Fair · Site: Pain, Swelling · Joint pains, Muscle or body aches
    Free text: Pain underneath my left arm pit wheras, the 2nd booster was injected in my left deltoid myscle. Also, feeling lightheaded since, the injection on 6-22-22. On the even8ng after thecinjection on 6-22-22, I woke up at 3:18, 5:58am from the pain in my ar
    MedDRA releases: 2024-11 · check-in free text available
  15. 2022-06-25
    Survey response — days 1–6 daily, dose 4
    MedDRA: Axillary pain — Feeling: Fair · Site: Pain, Swelling
    Free text: Pain underneath my left arm-pjt is improving. I NEVER had that pain with the 3 previous Moderna shots. Those 3 shots wete given to me by my (b)(6) Health clinucians. This 2nd Moderna booster was given to me by the pharmacist at Waldgreens
    MedDRA releases: 2024-11 · check-in free text available
  16. 2022-06-26
    Survey response — days 1–6 daily, dose 4
    MedDRA: Axillary pain — Feeling: Good · Site: Pain
    Free text: Mild pain underneath my left armpit(gland?).2nd Moderna booster was taken on 6-22-22 in the left deltoid muscle.
    MedDRA releases: 2024-11 · check-in free text available
  17. 2022-06-27
    Health check-in — days 1–6 daily, dose 4
    Feeling: Good · None
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-02-04Moderna
22021-03-04Moderna No
32021-11-30Moderna No
42022-06-22Moderna No

Free text

Release 3 — days 1–6 daily, dose 1

2021-02-06

Systemic reaction (other): Headache for 3 days(worst part)-severe chills at sleep(2days)-light cough-lack of appetite

2021-02-07

Systemic reaction (other): Lack of appetite, defecating more, continued headache, slight cough.

2021-02-08

Systemic reaction (other): Slight cough, runny nose(a little).

Release 12 — days 1–6 daily, dose 4

2022-06-24

Systemic reaction (other): Pain underneath my left arm pit wheras, the 2nd booster was injected in my left deltoid myscle. Also, feeling lightheaded since, the injection on 6-22-22. On the even8ng after thecinjection on 6-22-22, I woke up at 3:18, 5:58am from the pain in my ar cut off by CDC

2022-06-25

Systemic reaction (other): Pain underneath my left arm-pjt is improving. I NEVER had that pain with the 3 previous Moderna shots. Those 3 shots wete given to me by my (b)(6) Health clinucians. This 2nd Moderna booster was given to me by the pharmacist at Waldgreens
redacted (b)(6)

2022-06-26

Systemic reaction (other): Mild pain underneath my left armpit(gland?).2nd Moderna booster was taken on 6-22-22 in the left deltoid muscle.

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
SROAxillary pain · · ✓
SROChills ✓ ✓ ✓
SROCough ✓ ✓ ✓
SRODecreased appetite ✓ ✓ ✓
SRODizziness · · ✓
SROFrequent bowel movements ✓ ✓ ✓
SROHeadache ✓ ✓ ✓
SROPain in extremity · · ✓
SRORhinorrhoea ✓ ✓ ✓
SROSleep disorder · · ✓

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