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
-
2021-04-12
Dose 1 — Moderna
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2021-04-13
Registered in v-safe
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2021-04-13
Survey response — days 1–6 daily, dose 1MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness, Nausea · Be unable to work, Be unable to do your normal daily activitiesFree 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
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2021-04-14
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain, Swelling · Fever · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-04-15
Survey response — days 1–6 daily, dose 1MedDRA: Therapeutic response unexpected — Feeling: Good · Site: SwellingFree 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
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2021-04-16
Survey response — days 1–6 daily, dose 1MedDRA: Laryngitis — Feeling: Fair · Site: Swelling · Be unable to do your normal daily activitiesFree text: I developed laryngitisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-17
Survey response — days 1–6 daily, dose 1MedDRA: Laryngitis — Feeling: Fair · Site: Swelling · Be unable to do your normal daily activitiesFree text: laryingitisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-19
Survey response — days 1–6 daily, dose 1MedDRA: Laryngitis — Feeling: Good · Site: SwellingFree text: laryngitisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-21
- 2021-04-26
- 2021-05-03
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2021-05-10
Dose 2 — Moderna
- 2021-05-10
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2021-05-11
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · None · Be unable to do your normal daily activitiesAdult check-in
- 2021-05-12
- 2021-05-13
- 2021-05-14
- 2021-05-16
- 2021-05-17
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2021-05-24
Survey response — day 14, dose 2MedDRA: Bronchitis viral, Hospitalisation — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree 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
- 2021-06-02
- 2021-06-07
- 2021-06-14
- 2021-06-21
- 2021-08-09
- 2021-11-08
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2022-05-10
Survey response — 12 months, dose 2MedDRA: 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 consultationFree text: I acquired my second Covid infection.MedDRA releases: 2024-11 · check-in free text available
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2022-05-10
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · 1 call case(s)
- 2022-05-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-12 | Moderna | |
| 2 | 2021-05-10 | Moderna |
Call center
1 call center case
1 unsuccessful
Free text
Release 7 — days 1–6 daily, dose 1
Systemic reaction (other): yes. had covid in january. my vision was terrible thereafter. it significantly improved.
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.
Systemic reaction (other): I developed laryngitis
Systemic reaction (other): laryingitis
Systemic reaction (other): laryngitis
Release 8 — day 14, dose 2
Symptoms: I developed a viral bronchitis and was hospitalized for two days.
Release 11 — 12 months, dose 2
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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| SD | Bronchitis viral | ✓ | ✓ | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SRO | Laryngitis | ✓ | ✓ | ✓ |
| SRO | Therapeutic response unexpected | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release