3N5-13909-27412
5 vaccinations
6 coded responses
48 check-ins
5 free-text entries
4 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 860 / AZ
- Registered
- 2021-02-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-13
Registered in v-safe
-
2021-02-13
Dose 1 — Moderna
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-20
- 2021-02-27
- 2021-03-06
- 2021-03-13
-
2021-03-15
Dose 2 — Moderna
- 2021-03-15
-
2021-03-16
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
-
2021-03-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-18
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-19
- 2021-03-20
- 2021-03-21
- 2021-03-22
- 2021-03-29
- 2021-04-05
-
2021-04-12
Survey response — day 28, dose 2MedDRA: Tinnitus — Feeling: GoodFree text: Tinnitus. For the past 2-3 weeks, a constant, high-pitched ringing in both ears. Not debilitating but certainly noticeable, indoors and out. I plan to see a doctor.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-19
Survey response — day 35, dose 2MedDRA: Tinnitus — Feeling: GoodFree text: I have had tinnitus for about three weeks. It is not growing worse but it is persisting.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-26
- 2021-06-16
- 2021-09-13
-
2021-12-10
Dose 3 — Moderna
-
2022-03-15
Survey response — 12 months, dose 2MedDRA: Gastrointestinal carcinoma, Gastrointestinal haemorrhage, Gastrointestinal stromal tumour, Hospitalisation, Pulmonary embolism, Rehabilitation therapy — 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 · Emergency room or emergency department visit, HospitalizationFree text: Symptoms: Not related to COVID. In October I had a pulmonary embolism and GI bleed caused by a malignant Gastrointestinal Stromal Tumor, which was removed. No metastasis or recurrence. Now, possible prostate cancer. Still being evaluated. · Healthcare visit (other): rehab hospital post-surgeryMedDRA releases: 2024-11 · check-in free text available
-
2022-03-15
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 prEmergency room or emergency department visit · Hospitalization · 1 call case(s)
-
2022-03-16
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-05-25
Dose 4 — Moderna
- 2022-05-26
- 2022-05-27
- 2022-05-28
- 2022-05-29
- 2022-05-30
- 2022-05-31
- 2022-06-01
- 2022-06-08
- 2022-06-17
- 2022-06-22
- 2022-06-30
- 2022-07-07
-
2022-08-25
Survey response — 3 months, dose 4MedDRA: Prostate cancer — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: I was diagnosed with prostate cancer a few months ago and will start radiation treatment in September.MedDRA releases: 2024-11 · check-in free text available
-
2022-08-25
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-08-26
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-10-17
Dose 5 — ModernaCo-administered: Flu
-
2022-10-26
Survey response — day 7, dose 5MedDRA: Hormone therapy, Pre-existing disease, Radiotherapy — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Today I completed my final (of 20) radiation treatment for prostate cancer. I am also receiving hormone therapy, which will continue for at least 17 more months.MedDRA releases: 2024-11 · check-in free text available
-
2022-10-26
Report sent to call center — day 7, dose 5Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-10-28
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2022-11-01
- 2022-11-07
- 2022-11-16
- 2022-11-21
- 2022-11-29
- 2023-01-16
-
2023-04-17
Survey response — 6 months, dose 5MedDRA: SARS-CoV-2 test positive — 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, Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
-
2023-04-17
Report sent to call center — 6 months, dose 5Be 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 · Outpatient clinic or urgent care clinic visit · 1 call case(s)
- 2023-04-18
-
2023-04-18
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-13 | Moderna | |
| 2 | 2021-03-15 | Moderna | |
| 3 | 2021-12-10 | Moderna | No |
| 4 | 2022-05-25 | Moderna | No |
| 5 | 2022-10-17 | Moderna | Flu |
Call center
4 call center cases
4 successful
Free text
Release 7 — day 28, dose 2
Symptoms: Tinnitus. For the past 2-3 weeks, a constant, high-pitched ringing in both ears. Not debilitating but certainly noticeable, indoors and out. I plan to see a doctor.
Release 7 — day 35, dose 2
Symptoms: I have had tinnitus for about three weeks. It is not growing worse but it is persisting.
Release 11 — 12 months, dose 2
Symptoms: Not related to COVID. In October I had a pulmonary embolism and GI bleed caused by a malignant Gastrointestinal Stromal Tumor, which was removed. No metastasis or recurrence. Now, possible prostate cancer. Still being evaluated.
Healthcare visit (other): rehab hospital post-surgery
Release 12 — 3 months, dose 4
Symptoms: I was diagnosed with prostate cancer a few months ago and will start radiation treatment in September.
Release 12 — day 7, dose 5
Systemic reaction (other): Today I completed my final (of 20) radiation treatment for prostate cancer. I am also receiving hormone therapy, which will continue for at least 17 more months.
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 | Hospitalisation | · | · | ✓ |
| HCVO | Rehabilitation therapy | · | · | ✓ |
| SD | Gastrointestinal carcinoma | · | · | ✓ |
| SD | Gastrointestinal haemorrhage | · | · | ✓ |
| SD | Gastrointestinal stromal tumour | · | · | ✓ |
| SD | Prostate cancer | · | · | ✓ |
| SD | Pulmonary embolism | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Tinnitus | ✓ | ✓ | ✓ |
| SRO | Hormone therapy | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
| SRO | Radiotherapy | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release