2VJ-14407-67518
2 vaccinations
3 coded responses
24 check-ins
3 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 100 / NY
- Registered
- 2020-12-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2020-12-30
Registered in v-safe
-
2020-12-30
Dose 1 — Moderna
- 2020-12-30
- 2020-12-31
- 2021-01-02
- 2021-01-03
- 2021-01-04
- 2021-01-05
- 2021-01-06
- 2021-01-13
- 2021-01-21
-
2021-01-27
Dose 2 — Moderna
- 2021-01-27
-
2021-01-28
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fever · Fatigue or tirednessAdult check-in
- 2021-01-29
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-10
- 2021-02-17
- 2021-02-24
-
2021-03-03
Survey response — day 35, dose 2MedDRA: Discomfort, Eye pain, Fatigue, Flushing, Food poisoning, Self-medication — Feeling: Good · Be unable to do your normal daily activitiesFree text: Suddenly flushed, pain behind eyes and terribly tired. I washed my face with cold water to relieve discomfort, took a nap then took advil and gradually improved. Next day almost gone. May have been from food sensitivity or food poisoning.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-10
Survey response — day 42, dose 2MedDRA: Nasopharyngitis, Rhinorrhoea — Feeling: Good · Be unable to do your normal daily activitiesFree text: Cold, bad sniffles, maybe feverishMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-28
- 2021-07-29
-
2022-01-27
Survey response — 12 months, dose 2MedDRA: COVID-19, Fatigue, Hernia repair, Oxygen saturation decreased, Pyrexia — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Very high fever when covid started. Slightly lower oxygen level for couple of days. Sudden onset of tiredness End of December had hernia surgeryMedDRA releases: 2024-11 · check-in free text available
-
2022-01-27
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-02-02
-
2022-02-08
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-30 | Moderna | |
| 2 | 2021-01-27 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 5 — day 35, dose 2
Symptoms: Suddenly flushed, pain behind eyes and terribly tired. I washed my face with cold water to relieve discomfort, took a nap then took advil and gradually improved. Next day almost gone. May have been from food sensitivity or food poisoning.
Release 5 — day 42, dose 2
Symptoms: Cold, bad sniffles, maybe feverish
Release 11 — 12 months, dose 2
Symptoms: Very high fever when covid started. Slightly lower oxygen level for couple of days. Sudden onset of tiredness End of December had hernia surgery
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 | COVID-19 | · | · | ✓ |
| SD | Discomfort | · | · | ✓ |
| SD | Eye pain | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Flushing | ✓ | ✓ | ✓ |
| SD | Food poisoning | ✓ | ✓ | ○ |
| SD | Hernia repair | · | · | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Oxygen saturation decreased | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Rhinorrhoea | ✓ | ✓ | ✓ |
| SD | Self-medication | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release