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3M9-75103-99450

2 vaccinations 4 coded responses 15 check-ins 4 free-text entries 1 call case
Sex
Male
Age at first dose
66+
ZIP prefix
803 / CO
Registered
2021-01-14
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-11
    Dose 1 — Moderna
  2. 2021-01-14
    Registered in v-safe
  3. 2021-01-14
    Health check-in — days 1–6 daily, dose 1
    Feeling: Fair · Site: Pain · None
    Adult check-in
  4. 2021-01-15
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · Muscle or body aches
    Adult check-in
  5. 2021-01-17
    Survey response — days 1–6 daily, dose 1
    MedDRA: Diarrhoea — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, Diarrhea
    Free text: Diarrhea highly likely due to other drug side effects
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-01-19
    Health check-in — day 7, dose 1
    Feeling: Fair · None
    Adult check-in
  7. 2021-01-25
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  8. 2021-02-02
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  9. 2021-02-08
    Dose 2 — Moderna
  10. 2021-02-17
    Health check-in — day 7, dose 2
    Feeling: Good · Chills, Diarrhea
    Adult check-in
  11. 2021-02-23
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  12. 2021-03-03
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  13. 2021-03-09
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-03-15
    Survey response — day 35, dose 2
    MedDRA: Adverse reaction — Feeling: Fair · Be unable to do your normal daily activities
    Free text: I take drugs for Meyloma. One of the drugs periodically causes me distress. Ive been sick from drug side effects for 3 days. Hope & expect to be better soon.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  15. 2021-03-24
    Survey response — day 42, dose 2
    MedDRA: Fatigue, Myalgia, Pre-existing disease, Somnolence — Feeling: Fair · Be unable to work
    Free text: Muscle ache, tired. Sleep much of the day. Believe it is side effect of cancer drug. Not due to vaccine.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  16. 2021-05-10
    Survey response — 3 months, dose 2
    MedDRA: Bone disorder, Bone pain, Office visit — Feeling: Fair · 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: Symptoms: Upper left arm bone detoriation & pain. Surgery tomorrow to place a titanium rod in the none · Healthcare visit (other): In person meeting
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-05-10
    Report sent to call center — 3 months, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  18. 2021-08-09
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  19. 2022-02-08
    Health check-in — 12 months, dose 2
    Feeling: Good
    Adult check-in
  20. 2022-04-18
    Call successful
    Not applicable - Accidental Reporting

Vaccinations

DoseDateManufacturerCo-administered
12021-01-11Moderna
22021-02-08Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 2 — days 1–6 daily, dose 1

2021-01-17

Systemic reaction (other): Diarrhea highly likely due to other drug side effects

Release 5 — day 35, dose 2

2021-03-15

Symptoms: I take drugs for Meyloma. One of the drugs periodically causes me distress. Ive been sick from drug side effects for 3 days. Hope & expect to be better soon.

Release 6 — day 42, dose 2

2021-03-24

Symptoms: Muscle ache, tired. Sleep much of the day. Believe it is side effect of cancer drug. Not due to vaccine.

Release 8 — 3 months, dose 2

2021-05-10

Symptoms: Upper left arm bone detoriation & pain. Surgery tomorrow to place a titanium rod in the none
Healthcare visit (other): In person meeting

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
HCVOOffice visit ✓ ✓ ✓
SDAdverse reaction ✓ ✓ ✓
SDBone disorder ✓ ✓ ✓
SDBone pain ✓ ✓ ✓
SDFatigue ✓ ✓ ✓
SDMyalgia ✓ ✓ ✓
SDPre-existing disease ✓ ✓ ✓
SDSomnolence ✓ ✓ ✓
SRODiarrhoea ✓ ✓ ✓

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