3LJ-99635-64015
2 vaccinations
5 coded responses
24 check-ins
5 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 220 / VA
- Registered
- 2021-01-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-19
Registered in v-safe
-
2021-01-19
Dose 1 — Moderna
- 2021-01-19
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-28
- 2021-02-02
- 2021-02-09
-
2021-02-18
Survey response — day 28, dose 1MedDRA: Abdominal distension, Dyspepsia, Fatigue, Malaise, Office visit, Pyrexia, SARS-CoV-2 test — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: malaise, fatigue, fever max 100.8 (normal 97.5), bloated stomach, heartburn Sat 13 Feb nite thru Mon 15 Feb nite. Dr auth C-19 nose swab test on Mon 1100. Result 'not indicated rptd on wed. Recheded Shot 2 for wed 24 Feb · Healthcare visit (other): Dr ofc driveby c19 testMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-18
Report sent to call center — day 28, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-02-24
Dose 2 — Moderna
- 2021-02-24
-
2021-02-25
Survey response — days 1–6 daily, dose 2MedDRA: Pain in extremity — Feeling: GoodFree text: sore left arm below inj siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-02-26
Survey response — days 1–6 daily, dose 2MedDRA: Pain in extremity — Feeling: Good · Site: PainFree text: mild sore arm below inj site- less than yesterdayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-27
- 2021-02-28
-
2021-03-01
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue, Insomnia, Nausea — Feeling: Fair · Fatigue or tiredness, NauseaFree text: slight nausea after waking but subsided after eating. fatigue probably due to short night's sleep.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-02
- 2021-03-03
- 2021-03-11
- 2021-03-17
-
2021-03-24
Survey response — day 28, dose 2MedDRA: Nasal congestion, Nasopharyngitis, Oropharyngeal pain — Feeling: FairFree text: cold-like sore throat, stuffy nose starting last nite. This am normal temp & oxygenation, BP 130/65p52 higher than my normal below 120.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-02
- 2021-04-08
- 2021-05-26
- 2021-08-10
- 2021-08-25
- 2022-02-24
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-19 | Moderna | |
| 2 | 2021-02-24 | Moderna |
Call center
1 call center case
1 unsuccessful
1 wait over 3 months for a first call
Free text
Release 4 — day 28, dose 1
Symptoms: malaise, fatigue, fever max 100.8 (normal 97.5), bloated stomach, heartburn Sat 13 Feb nite thru Mon 15 Feb nite. Dr auth C-19 nose swab test on Mon 1100. Result 'not indicated rptd on wed. Recheded Shot 2 for wed 24 Feb
Healthcare visit (other): Dr ofc driveby c19 test
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): sore left arm below inj site
Systemic reaction (other): mild sore arm below inj site- less than yesterday
Systemic reaction (other): slight nausea after waking but subsided after eating. fatigue probably due to short night's sleep.
Release 6 — day 28, dose 2
Symptoms: cold-like sore throat, stuffy nose starting last nite. This am normal temp & oxygenation, BP 130/65p52 higher than my normal below 120.
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 | Office visit | ✓ | ✓ | ✓ |
| HCVO | SARS-CoV-2 test | ✓ | ✓ | ✓ |
| SD | Abdominal distension | ✓ | ✓ | ✓ |
| SD | Dyspepsia | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Malaise | ✓ | ✓ | ✓ |
| SD | Nasal congestion | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | ✓ | ✓ | ✓ |
| SD | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | SARS-CoV-2 test | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
| SRO | Nausea | ✓ | ✓ | ✓ |
| SRO | Pain in extremity | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release