3T4-31809-53690
1 vaccination
3 coded responses
12 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 472 / IN
- Registered
- 2021-02-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-28
Registered in v-safe
-
2021-02-28
Dose 1 — Moderna
- 2021-02-28
-
2021-03-01
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Swelling · Fatigue or tirednessAdult check-in
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2021-03-02
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Itching · ChillsAdult check-in
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
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2021-03-14
Survey response — day 14, dose 1MedDRA: Decreased appetite, Fatigue, Headache, Pain, Pyrexia, Somnolence — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Had a fever, headache, fatigue, body aches, and loss of appetite. Started late Friday. Slept most of day Saturday. Much better today. Temp near normal.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-21
Survey response — day 21, dose 1MedDRA: Blood pressure increased, Palpitations, Peripheral coldness, Pharyngeal swelling — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Increased blood pressure, heart palpitations, slightly swollen throat. Unusual coldness of left hand.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-21
Report sent to call center — day 21, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2021-03-28
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2021-08-29
Survey response — 6 months, dose 1MedDRA: Arrhythmia, Myocarditis, Office visit — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Shortly after vaccination, have been battling Myocarditis for last 6 months. I think I am slowly recovering but still having issues with heart arrhythmia. My Cardiologist tells me it may not ever completely go away.MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-29
Report sent to call center — 6 months, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
-
2021-08-31
Call successfulCompleted over the phone
- 2022-03-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-28 | Moderna |
Call center
2 call center cases
2 successful
VAERS report filed, before or during a call: 2
Free text
Release 5 — day 14, dose 1
Symptoms: Had a fever, headache, fatigue, body aches, and loss of appetite. Started late Friday. Slept most of day Saturday. Much better today. Temp near normal.
Release 6 — day 21, dose 1
Symptoms: Increased blood pressure, heart palpitations, slightly swollen throat. Unusual coldness of left hand.
Release 9 — 6 months, dose 1
Symptoms: Shortly after vaccination, have been battling Myocarditis for last 6 months. I think I am slowly recovering but still having issues with heart arrhythmia. My Cardiologist tells me it may not ever completely go away.
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 | Arrhythmia | ✓ | · | ✓ |
| SD | Blood pressure increased | ✓ | ✓ | ✓ |
| SD | Decreased appetite | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Myocarditis | ✓ | · | ✓ |
| SD | Office visit | ✓ | · | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Palpitations | ✓ | ✓ | ✓ |
| SD | Peripheral coldness | ✓ | ✓ | ✓ |
| SD | Pharyngeal swelling | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Somnolence | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release