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3M9-17386-99468

2 vaccinations 7 coded responses 24 check-ins 7 free-text entries 1 call case
Sex
Male
Age at first dose
66+
ZIP prefix
852 / AZ
Registered
2021-04-13
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-04-12
    Dose 1 — Moderna
  2. 2021-04-13
    Registered in v-safe
  3. 2021-04-13
    Survey response — days 1–6 daily, dose 1
    MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activities
    Free text: yes. had covid in january. my vision was terrible thereafter. it significantly improved.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-04-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain, Swelling · Fever · Fatigue or tiredness · Be unable to do your normal daily activities
    Adult check-in
  5. 2021-04-15
    Survey response — days 1–6 daily, dose 1
    MedDRA: Therapeutic response unexpected — Feeling: Good · Site: Swelling
    Free text: I acquired a Covid infection in January 2021. Subsequently, my vision deteriorated and I thought I needed retinal surgery. After receiving the moderna vaccine, my vision has significantly improved.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-04-16
    Survey response — days 1–6 daily, dose 1
    MedDRA: Laryngitis — Feeling: Fair · Site: Swelling · Be unable to do your normal daily activities
    Free text: I developed laryngitis
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-04-17
    Survey response — days 1–6 daily, dose 1
    MedDRA: Laryngitis — Feeling: Fair · Site: Swelling · Be unable to do your normal daily activities
    Free text: laryingitis
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-04-19
    Survey response — days 1–6 daily, dose 1
    MedDRA: Laryngitis — Feeling: Good · Site: Swelling
    Free text: laryngitis
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-04-21
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-04-26
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  11. 2021-05-03
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-05-10
    Dose 2 — Moderna
  13. 2021-05-10
    Health check-in — day 0, dose 2
    Feeling: Good · Site: Pain · None
    Adult check-in
  14. 2021-05-11
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · None · Be unable to do your normal daily activities
    Adult check-in
  15. 2021-05-12
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-05-13
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  17. 2021-05-14
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  18. 2021-05-16
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-05-17
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  20. 2021-05-24
    Survey response — day 14, dose 2
    MedDRA: Bronchitis viral, Hospitalisation — Feeling: Poor · Be unable to work, Be unable to do your normal daily activities
    Free text: I developed a viral bronchitis and was hospitalized for two days.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  21. 2021-06-02
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-06-07
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-06-14
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-06-21
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-08-09
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-11-08
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  27. 2022-05-10
    Survey response — 12 months, dose 2
    MedDRA: COVID-19 — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation
    Free text: I acquired my second Covid infection.
    MedDRA releases: 2024-11 · check-in free text available
  28. 2022-05-10
    Report sent to call center — 12 months, dose 2
    Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr
    Telehealth, virtual health, or email health consultation · 1 call case(s)
  29. 2022-05-11

Vaccinations

DoseDateManufacturerCo-administered
12021-04-12Moderna
22021-05-10Moderna

Call center

1 call center case

1 unsuccessful

See the call center timeline

Free text

Release 7 — days 1–6 daily, dose 1

2021-04-13

Systemic reaction (other): yes. had covid in january. my vision was terrible thereafter. it significantly improved.

2021-04-15

Systemic reaction (other): I acquired a Covid infection in January 2021. Subsequently, my vision deteriorated and I thought I needed retinal surgery. After receiving the moderna vaccine, my vision has significantly improved.

2021-04-16

Systemic reaction (other): I developed laryngitis

2021-04-17

Systemic reaction (other): laryingitis

2021-04-19

Systemic reaction (other): laryngitis

Release 8 — day 14, dose 2

2021-05-24

Symptoms: I developed a viral bronchitis and was hospitalized for two days.

Release 11 — 12 months, dose 2

2022-05-10

Symptoms: I acquired my second Covid infection.

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
SDBronchitis viral ✓ ✓ ✓
SDCOVID-19 · · ✓
SDHospitalisation ✓ ✓ ✓
SROLaryngitis ✓ ✓ ✓
SROTherapeutic response unexpected ✓ ✓ ✓
SROUnevaluable event ✓ ✓ ✓

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