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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

  1. 2021-04-16
    Registered in v-safe
  2. 2021-04-16
    Dose 1 — Moderna
  3. 2021-04-16
    Health check-in — day 0, dose 1
    Feeling: Good · Site: Pain · None
    Adult check-in
  4. 2021-04-17
    Survey response — days 1–6 daily, dose 1
    MedDRA: Feeling cold, Nausea — Feeling: Good · Site: Pain · Fatigue or tiredness
    Free 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
  5. 2021-04-19
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Fatigue or tiredness
    Adult check-in
  6. 2021-04-20
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-04-21
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-04-22
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-04-23
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-04-30
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-05-07
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-05-14
    Dose 2 — Moderna
  13. 2021-05-14
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  14. 2021-05-15
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  15. 2021-05-16
    Survey response — days 1–6 daily, dose 2
    MedDRA: Heart rate increased — Feeling: Fair · Site: Pain, Swelling · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Accelerated heart rate (actually yesterday)
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-05-17
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain, Swelling · Fatigue or tiredness
    Adult check-in
  17. 2021-05-18
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · None
    Adult check-in
  18. 2021-05-19
    Survey response — days 1–6 daily, dose 2
    MedDRA: Musculoskeletal discomfort, Pruritus, Rash — Feeling: Good · Site: Pain · Rash, not including the immediate area around the injection site
    Free 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
  19. 2021-05-20
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-05-21
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  21. 2021-05-28
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-06-04
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-06-11
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-06-18
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-06-25
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-08-13
    Survey response — 3 months, dose 2
    MedDRA: Chest discomfort, Chills, Dyspnoea, Pyrexia — Feeling: Fair
    Free 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
  27. 2021-11-12
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  28. 2022-05-14
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-04-16Moderna
22021-05-14Moderna

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-17

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

2021-05-16

Systemic reaction (other): Accelerated heart rate (actually yesterday)

2021-05-19

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

2021-08-13

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

FieldPreferred term2021-092023-042024-11
SDChest discomfort ✓ · ✓
SDChills ✓ · ✓
SDDyspnoea ✓ · ✓
SDPyrexia ✓ · ✓
SROFeeling cold ✓ ✓ ✓
SROHeart rate increased ✓ ✓ ✓
SROMusculoskeletal discomfort ✓ ✓ ✓
SRONausea ✓ ✓ ✓
SROPruritus ✓ ✓ ✓
SRORash ✓ ✓ ✓

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