3KM-19099-11780
5 vaccinations
6 coded responses
62 check-ins
6 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 917 / CA
- Registered
- 2021-02-19
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-19
Registered in v-safe
-
2021-02-19
Dose 1 — Moderna
- 2021-02-19
- 2021-02-20
- 2021-02-21
-
2021-02-22
Survey response — days 1–6 daily, dose 1MedDRA: Pruritus — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: Itching could be due to dry skin not sureMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-23
- 2021-02-24
-
2021-02-25
Survey response — days 1–6 daily, dose 1MedDRA: Nasopharyngitis, Sneezing — Feeling: Fair · HeadacheFree text: Colds sneezingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-26
-
2021-03-05
Survey response — day 14, dose 1MedDRA: Feeling hot, Headache, Self-medication — Feeling: GoodFree text: I feel warm today but temperature is normal. Few mild headaches here and there but not strong enough to make me take Tylenol, unlike that one day during first week of shot. I had to take 2 pills.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-12
-
2021-03-19
Dose 2 — Moderna
-
2021-03-19
Survey response — day 0, dose 2MedDRA: Fatigue, Self-medication, Somnolence — Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Sleepiness perhaps due to benadryl i took. I couldn't do anything as i feel sleepy and tired.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-20
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-03-24
- 2021-03-25
- 2021-03-26
- 2021-04-02
- 2021-04-09
- 2021-04-16
- 2021-04-23
- 2021-04-30
- 2021-06-18
- 2021-09-17
-
2021-11-05
Dose 3 — Moderna
- 2021-11-05
-
2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · HeadacheAdult check-in
-
2021-11-07
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fever · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-11-08
- 2021-11-09
- 2021-11-10
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2021-12-17
-
2022-02-04
Survey response — 3 months, dose 3MedDRA: SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend schoolFree text: Tested positive covidMedDRA releases: 2024-11 · check-in free text available
-
2022-05-05
Dose 4 — Pfizer-BioNTech
-
2022-05-05
Survey response — day 0, dose 4MedDRA: Muscular weakness — Feeling: Good · Fatigue or tirednessFree text: Right arm feels weak (shot not on left deltoid as recorded by CVS)MedDRA releases: 2024-11 · check-in free text available
- 2022-05-06
- 2022-05-09
- 2022-05-10
- 2022-05-11
- 2022-05-12
- 2022-05-19
- 2022-06-02
- 2022-06-09
- 2022-06-16
- 2022-08-04
-
2022-10-27
Dose 5 — Moderna
- 2022-10-27
-
2022-10-28
Health check-in — days 1–6 daily, dose 5Feeling: Fair · Site: Pain · Fever · Chills, Joint pains, Muscle or body aches · Be unable to work or attend schoolAdult check-in
- 2022-10-29
- 2022-10-30
- 2022-11-01
- 2022-11-02
- 2022-11-03
- 2022-11-10
- 2022-11-17
- 2022-11-24
- 2022-12-01
- 2022-12-08
- 2023-04-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-19 | Moderna | |
| 2 | 2021-03-19 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
| 4 | 2022-05-05 | Pfizer-BioNTech | No |
| 5 | 2022-10-27 | Moderna | No |
Free text
Release 4 — days 1–6 daily, dose 1
Systemic reaction (other): Itching could be due to dry skin not sure
Systemic reaction (other): Colds sneezing
Release 5 — day 14, dose 1
Symptoms: I feel warm today but temperature is normal. Few mild headaches here and there but not strong enough to make me take Tylenol, unlike that one day during first week of shot. I had to take 2 pills.
Release 5 — day 0, dose 2
Systemic reaction (other): Sleepiness perhaps due to benadryl i took. I couldn't do anything as i feel sleepy and tired.
Release 11 — 3 months, dose 3
Symptoms: Tested positive covid
Release 11 — day 0, dose 4
Systemic reaction (other): Right arm feels weak (shot not on left deltoid as recorded by CVS)
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 | Feeling hot | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Self-medication | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Muscular weakness | · | · | ✓ |
| SRO | Nasopharyngitis | ✓ | ✓ | ✓ |
| SRO | Pruritus | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Sneezing | ✓ | ✓ | ✓ |
| SRO | Somnolence | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release