3K9-13401-36941
4 vaccinations
6 coded responses
22 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 31-35
- ZIP prefix
- 346 / FL
- Registered
- 2021-11-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
4JG-21881-55584
Child or adolescent in my care · Male · 2021-11-10
Timeline
-
2021-04-06
Dose 1 — Moderna
-
2021-05-04
Dose 2 — Moderna
-
2021-11-10
Registered in v-safe
-
2021-11-17
Dose 3 — Moderna
- 2021-11-17
- 2021-11-18
- 2021-11-19
- 2021-11-20
- 2021-11-21
- 2021-11-22
- 2021-11-23
- 2021-11-24
- 2021-12-01
- 2021-12-08
-
2021-12-17
Survey response — day 28, dose 3MedDRA: Cough, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: GoodFree text: Cough and runny nose, I've taken a Covid test and it was negative.MedDRA releases: 2024-11 · check-in free text available
- 2021-12-22
-
2021-12-29
Survey response — day 42, dose 3MedDRA: Exposure to SARS-CoV-2, Headache — Feeling: FairFree text: Headache. Was exposed to Covid on 12/25 and my 3 year old daughter tested positive 12/28. I have a pcr scheduled for 12/30MedDRA releases: 2024-11 · check-in free text available
-
2022-02-18
Survey response — 3 months, dose 3MedDRA: Cough, Headache, Rhinorrhoea, SARS-CoV-2 test negative — Feeling: Good · Be unable to work or attend schoolFree text: Cough, headache runny nose tested negative for Covid twice during symptomsMedDRA releases: 2024-11 · check-in free text available
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2022-05-18
Survey response — 6 months, dose 3MedDRA: COVID-19, Cough, Fatigue, Headache, Nasal congestion, Oropharyngeal pain — Feeling: Fair · Be unable to work or attend schoolFree text: Caught Covid At Dell technology world in (b)(6). Fatigue, headache, cough, sore throat, stuffy noseMedDRA releases: 2024-11 · check-in free text available
-
2022-09-07
Dose 4 — Moderna
- 2022-09-24
- 2022-09-28
- 2022-10-07
- 2022-10-12
-
2022-10-21
Survey response — day 42, dose 4MedDRA: Nasal congestion, Oropharyngeal pain — Feeling: FairFree text: Stuffy nose, sore throatMedDRA releases: 2024-11 · check-in free text available
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2022-12-07
Survey response — 3 months, dose 4MedDRA: Ear infection, Nasopharyngitis — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Got an ear infection and coldMedDRA releases: 2024-11 · check-in free text available
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2022-12-07
Report sent to call center — 3 months, dose 4Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-12-08
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-03-08
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-06 | Moderna | No |
| 2 | 2021-05-04 | Moderna | No |
| 3 | 2021-11-17 | Moderna | No |
| 4 | 2022-09-07 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 10 — day 28, dose 3
Symptoms: Cough and runny nose, I've taken a Covid test and it was negative.
Release 10 — day 42, dose 3
Symptoms: Headache. Was exposed to Covid on 12/25 and my 3 year old daughter tested positive 12/28. I have a pcr scheduled for 12/30
Release 11 — 3 months, dose 3
Symptoms: Cough, headache runny nose tested negative for Covid twice during symptoms
Release 11 — 6 months, dose 3
Symptoms: Caught Covid At Dell technology world in (b)(6). Fatigue, headache, cough, sore throat, stuffy nose
redacted (b)(6)
Release 12 — day 42, dose 4
Symptoms: Stuffy nose, sore throat
Release 12 — 3 months, dose 4
Symptoms: Got an ear infection and cold
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 | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Ear infection | · | · | ✓ |
| SD | Exposure to SARS-CoV-2 | · | · | ✓ |
| SD | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Nasal congestion | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release