3FB-97769-30127
5 vaccinations
2 coded responses
64 check-ins
2 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 074 / NJ
- Registered
- 2021-03-03
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-03
Registered in v-safe
-
2021-03-03
Dose 1 — Moderna
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-17
- 2021-03-24
-
2021-03-31
Dose 2 — Moderna
- 2021-03-31
- 2021-04-01
- 2021-04-02
- 2021-04-03
- 2021-04-04
- 2021-04-05
- 2021-04-06
- 2021-04-07
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-05-05
- 2021-05-12
- 2021-06-30
- 2021-09-29
-
2021-11-03
Dose 3 — Moderna
-
2021-11-04
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-05
- 2021-11-07
- 2021-11-08
- 2021-11-09
- 2021-11-11
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2021-12-15
- 2022-02-02
- 2022-05-04
-
2022-05-25
Dose 4 — Moderna
- 2022-05-25
-
2022-05-26
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Pain · Muscle or body achesAdult check-in
- 2022-05-27
- 2022-05-28
- 2022-05-29
- 2022-05-30
- 2022-05-31
- 2022-06-01
- 2022-06-08
- 2022-06-15
- 2022-06-22
- 2022-06-29
- 2022-07-06
-
2022-08-25
Survey response — 3 months, dose 4MedDRA: Computerised tomogram abnormal, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: A recent CT-scan indicate a tumor on left kidney and a vague lesion on right lobe of the liver. MRI of abdomen with or without contrast is warranted and appointment with a urologist. MRI and appointment with a urologist maybe scheduled soon. · Healthcare visit (other): Depending on findings of the urologist hospitalization may be necessary based MRI analysis.MedDRA releases: 2024-11 · check-in free text available
-
2022-08-25
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-08-26
-
2022-08-31
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-10-04
Dose 5 — Moderna
- 2022-10-07
- 2022-10-08
- 2022-10-09
- 2022-10-10
- 2022-10-12
- 2022-10-18
- 2022-10-25
- 2022-11-01
-
2022-11-08
Survey response — day 35, dose 5MedDRA: Body temperature increased, Cough, Fatigue, Pain, Pyrexia — Feeling: Good · Be unable to do your normal daily activitiesFree text: 1 day 101.4 F fever with body aches some coughing, and fatigue, 2 days with the same symptoms with 102.6 F fever, 1 day with same symptoms and 101.4 F fever. Last 3 days with mid 99 F fever and hardly any symptoms. Flu? 2 negative home antigen testsMedDRA releases: 2024-11 · check-in free text available
- 2022-11-15
- 2023-01-03
- 2023-04-04
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-03 | Moderna | |
| 2 | 2021-03-31 | Moderna | |
| 3 | 2021-11-03 | Moderna | No |
| 4 | 2022-05-25 | Moderna | No |
| 5 | 2022-10-04 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 12 — 3 months, dose 4
Symptoms: A recent CT-scan indicate a tumor on left kidney and a vague lesion on right lobe of the liver. MRI of abdomen with or without contrast is warranted and appointment with a urologist. MRI and appointment with a urologist maybe scheduled soon.
Healthcare visit (other): Depending on findings of the urologist hospitalization may be necessary based MRI analysis.
Release 12 — day 35, dose 5
Symptoms: 1 day 101.4 F fever with body aches some coughing, and fatigue, 2 days with the same symptoms with 102.6 F fever, 1 day with same symptoms and 101.4 F fever. Last 3 days with mid 99 F fever and hardly any symptoms. Flu? 2 negative home antigen tests cut off by CDC
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 |
|---|---|---|---|---|
| HCVO | Unevaluable event | · | · | ✓ |
| SD | Body temperature increased | · | · | ✓ |
| SD | Computerised tomogram abnormal | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release