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3DT-31507-10822

1 vaccination 4 coded responses 12 check-ins 4 free-text entries 0 call cases
Sex
Male
Age at first dose
66+
ZIP prefix
341 / FL
Registered
2021-03-12
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-03-11
    Dose 1 — Moderna
  2. 2021-03-12
    Registered in v-safe
  3. 2021-03-12
    Survey response — days 1–6 daily, dose 1
    MedDRA: Hypertension — Feeling: Good · Site: Pain
    Free text: Noticed blood pressure was high this morning and return to healthy normal by afternoon
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-03-13
    Survey response — days 1–6 daily, dose 1
    MedDRA: Blood pressure increased, Pain in extremity — Feeling: Good · Site: Pain
    Free text: My vaccine was 3/11. My left arm was sore that evening yet acceptable. Thought you might find it interesting the next day when I woke up my blood pressure was higher than normal. By mid morning my pressure was lower and acceptable and by late mid afternoon was normal and excellent. Today even better. Thought you might find interesting.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-03-15
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Fatigue or tiredness
    Adult check-in
  7. 2021-03-16
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-03-17
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-03-18
    Survey response — day 7, dose 1
    MedDRA: Dry eye, Feeling hot — Feeling: Fair · Fatigue or tiredness
    Free text: Eyes dry and a little warm
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-03-25
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-04-01
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-06-10
    Survey response — 3 months, dose 1
    MedDRA: Blood chromium increased, Blood cobalt increased, Device material issue — Feeling: Good
    Free text: My high Cobalt and Chromium level as the result of a defective right hip prosthetic shot up from a high level of 9 3/9/21 to 18 6/3/21. Probably no correlation.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-09-09
    Health check-in — 6 months, dose 1
    Feeling: Good
    Adult check-in
  14. 2022-03-11
    Health check-in — 12 months, dose 1
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-03-11Moderna

Free text

Release 5 — days 1–6 daily, dose 1

2021-03-12

Systemic reaction (other): Noticed blood pressure was high this morning and return to healthy normal by afternoon

2021-03-13

Systemic reaction (other): My vaccine was 3/11. My left arm was sore that evening yet acceptable. Thought you might find it interesting the next day when I woke up my blood pressure was higher than normal. By mid morning my pressure was lower and acceptable and by late mid afternoon was normal and excellent. Today even better. Thought you might find interesting.

Release 5 — day 7, dose 1

2021-03-18

Systemic reaction (other): Eyes dry and a little warm

Release 9 — 3 months, dose 1

2021-06-10

Symptoms: My high Cobalt and Chromium level as the result of a defective right hip prosthetic shot up from a high level of 9 3/9/21 to 18 6/3/21. Probably no correlation.

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
SDBlood chromium increased ✓ ✓ ✓
SDBlood cobalt increased ✓ ✓ ✓
SDDevice material issue ✓ ✓ ✓
SROBlood pressure increased ✓ ✓ ✓
SRODry eye ✓ ✓ ✓
SROFeeling hot ✓ ✓ ✓
SROHypertension ✓ ✓ ✓
SROPain in extremity ✓ ✓ ✓

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