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
-
2021-01-11
Dose 1 — Moderna
-
2021-01-14
Registered in v-safe
- 2021-01-14
-
2021-01-15
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2021-01-17
Survey response — days 1–6 daily, dose 1MedDRA: Diarrhoea — Feeling: Fair · Muscle or body aches, Fatigue or tiredness, DiarrheaFree text: Diarrhea highly likely due to other drug side effectsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-19
- 2021-01-25
- 2021-02-02
-
2021-02-08
Dose 2 — Moderna
- 2021-02-17
- 2021-02-23
- 2021-03-03
- 2021-03-09
-
2021-03-15
Survey response — day 35, dose 2MedDRA: Adverse reaction — Feeling: Fair · Be unable to do your normal daily activitiesFree 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
-
2021-03-24
Survey response — day 42, dose 2MedDRA: Fatigue, Myalgia, Pre-existing disease, Somnolence — Feeling: Fair · Be unable to workFree 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
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2021-05-10
Survey response — 3 months, dose 2MedDRA: 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 consultationFree text: Symptoms: Upper left arm bone detoriation & pain. Surgery tomorrow to place a titanium rod in the none · Healthcare visit (other): In person meetingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-10
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-09
- 2022-02-08
-
2022-04-18
Call successfulNot applicable - Accidental Reporting
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-11 | Moderna | |
| 2 | 2021-02-08 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Diarrhea highly likely due to other drug side effects
Release 5 — day 35, dose 2
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
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
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
| Field | Preferred term | 2021-09 | 2023-04 | 2024-11 |
|---|---|---|---|---|
| HCVO | Office visit | ✓ | ✓ | ✓ |
| SD | Adverse reaction | ✓ | ✓ | ✓ |
| SD | Bone disorder | ✓ | ✓ | ✓ |
| SD | Bone pain | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Myalgia | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Somnolence | ✓ | ✓ | ✓ |
| SRO | Diarrhoea | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release