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37X-55452-49127

1 vaccination 8 coded responses 10 check-ins 8 free-text entries 0 call cases
Sex
Male
Age at first dose
21-25
ZIP prefix
786 / TX
Registered
2021-08-06
Relationship
Adult relative or friend
Guardian
864-16040-30143
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-08-06
    Registered in v-safe
  2. 2021-08-06
    Dose 1 — Moderna
  3. 2021-08-06
    Survey response — day 0, dose 1, dependent
    MedDRA: Dizziness, Dyskinesia, Tremor, Vision blurred — Feeling: Poor · Chills, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Tremors, uncontrolled body movements and jerking, dizzy, blurred vision
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  4. 2021-08-07
    Survey response — days 1–6 daily, dose 1, dependent
    MedDRA: Asthenia, Dizziness, Tremor, Vision blurred — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Same, light tremors, blurred vision, weakness, dizziness, ,
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  5. 2021-08-08
    Survey response — days 1–6 daily, dose 1, dependent
    MedDRA: Diarrhoea, Fatigue, Mobility decreased — Feeling: Poor · Site: Pain · Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Extreme fatigue and diarrhea, cant get out of bed
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  6. 2021-08-09
    Survey response — days 1–6 daily, dose 1, dependent
    MedDRA: Fatigue, Mobility decreased, Muscular weakness — Feeling: Poor · Site: Pain · Headache, Fatigue or tiredness, Diarrhea · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Still extreme fatigue and muscle weakness, no ability to be productive, bed ridden!
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  7. 2021-08-10
    Survey response — days 1–6 daily, dose 1, dependent
    MedDRA: Fatigue — Feeling: Poor · Chills, Headache, Fatigue or tiredness · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Extreme fatigue
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  8. 2021-08-11
    Health check-in — days 1–6 daily, dose 1, dependent
    Feeling: Fair · None
    Adult check-in
  9. 2021-08-14
    Survey response — day 7, dose 1, dependent
    MedDRA: Cardiac flutter, Dyspnoea — Feeling: Poor · Joint pains, Fatigue or tiredness, Nausea, Rash, not including the immediate area around the injection site · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Heart fluttering, hard to breath, something is wrong
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  10. 2021-08-22
    Survey response — day 14, dose 1, dependent
    MedDRA: Cardiac disorder — Feeling: Poor · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Heart issues, having to wear a monitor and get scans
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  11. 2021-08-27
    Survey response — day 21, dose 1, dependent
    MedDRA: Cardiac disorder, Throat tightness — Feeling: Poor · Be unable to work or attend school, Be unable to do their normal daily activities
    Free text: Heart issues and throat constriction
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  12. 2021-11-07

Vaccinations

DoseDateManufacturerCo-administered
12021-08-06Moderna No

Free text

Release 9 — day 0, dose 1, dependent

2021-08-06

Systemic reaction (other): Tremors, uncontrolled body movements and jerking, dizzy, blurred vision

Release 9 — days 1–6 daily, dose 1, dependent

2021-08-07

Systemic reaction (other): Same, light tremors, blurred vision, weakness, dizziness, ,

2021-08-08

Systemic reaction (other): Extreme fatigue and diarrhea, cant get out of bed

2021-08-09

Systemic reaction (other): Still extreme fatigue and muscle weakness, no ability to be productive, bed ridden!

2021-08-10

Systemic reaction (other): Extreme fatigue

Release 9 — day 7, dose 1, dependent

2021-08-14

Systemic reaction (other): Heart fluttering, hard to breath, something is wrong

Release 9 — day 14, dose 1, dependent

2021-08-22

Symptoms: Heart issues, having to wear a monitor and get scans

Release 9 — day 21, dose 1, dependent

2021-08-27

Symptoms: Heart issues and throat constriction

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
SDCardiac disorder ✓ · ✓
SDThroat tightness ✓ · ✓
SROAsthenia ✓ · ✓
SROCardiac flutter ✓ · ✓
SRODiarrhoea ✓ · ✓
SRODizziness ✓ · ✓
SRODyskinesia ✓ · ✓
SRODyspnoea ✓ · ✓
SROFatigue ✓ · ✓
SROMobility decreased ✓ · ✓
SROMuscular weakness ✓ · ✓
SROTremor ✓ · ✓
SROVision blurred ✓ · ✓

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

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