3AK-17581-70347
2 vaccinations
4 coded responses
25 check-ins
4 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 604 / IL
- Registered
- 2021-04-16
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-16
Registered in v-safe
-
2021-04-16
Dose 1 — Moderna
- 2021-04-16
-
2021-04-17
Survey response — days 1–6 daily, dose 1MedDRA: Feeling cold, Nausea — Feeling: Good · Site: Pain · Fatigue or tirednessFree text: Yesterday I did feel really cold and slightly nauseous, but it was after I completed the check in. Neither of those symptoms returned today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-19
- 2021-04-20
- 2021-04-21
- 2021-04-22
- 2021-04-23
- 2021-04-30
- 2021-05-07
-
2021-05-14
Dose 2 — Moderna
- 2021-05-14
-
2021-05-15
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-05-16
Survey response — days 1–6 daily, dose 2MedDRA: Heart rate increased — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Accelerated heart rate (actually yesterday)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-17
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
- 2021-05-18
-
2021-05-19
Survey response — days 1–6 daily, dose 2MedDRA: Musculoskeletal discomfort, Pruritus, Rash — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection siteFree text: The rash is on my back (left side top). I actually noticed a little discomfort and itching a couple days ago, but didnt notice the rash.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-20
- 2021-05-21
- 2021-05-28
- 2021-06-04
- 2021-06-11
- 2021-06-18
- 2021-06-25
-
2021-08-13
Survey response — 3 months, dose 2MedDRA: Chest discomfort, Chills, Dyspnoea, Pyrexia — Feeling: FairFree text: On 8/9 I had chills and a low grade fever. Those subsided the next day. On 8/10 I started having shortness of breath and chest tightness which I continue to experience today.MedDRA releases: 2021-09,2024-11 · check-in free text available
- 2021-11-12
- 2022-05-14
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-16 | Moderna | |
| 2 | 2021-05-14 | Moderna |
Free text
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): Yesterday I did feel really cold and slightly nauseous, but it was after I completed the check in. Neither of those symptoms returned today.
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Accelerated heart rate (actually yesterday)
Systemic reaction (other): The rash is on my back (left side top). I actually noticed a little discomfort and itching a couple days ago, but didnt notice the rash.
Release 9 — 3 months, dose 2
Symptoms: On 8/9 I had chills and a low grade fever. Those subsided the next day. On 8/10 I started having shortness of breath and chest tightness which I continue to experience today.
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 | Chest discomfort | ✓ | · | ✓ |
| SD | Chills | ✓ | · | ✓ |
| SD | Dyspnoea | ✓ | · | ✓ |
| SD | Pyrexia | ✓ | · | ✓ |
| SRO | Feeling cold | ✓ | ✓ | ✓ |
| SRO | Heart rate increased | ✓ | ✓ | ✓ |
| SRO | Musculoskeletal discomfort | ✓ | ✓ | ✓ |
| SRO | Nausea | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release