3T6-19104-34729
2 vaccinations
3 coded responses
17 check-ins
3 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 945 / CA
- Registered
- 2021-02-10
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-03
Dose 1 — Moderna
-
2021-02-10
Registered in v-safe
-
2021-02-10
Survey response — day 7, dose 1MedDRA: Adverse reaction, No adverse event — Feeling: Good · Site: Pain · Headache, Fatigue or tiredness, Vomiting, Diarrhea · Be unable to work, Be unable to do your normal daily activitiesFree text: This happened on Feb 4 and better on the 5thMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-17
- 2021-02-24
-
2021-03-03
Dose 2 — Moderna
-
2021-03-03
Survey response — day 0, dose 2MedDRA: COVID-19, Malaise, Pre-existing disease — Feeling: GoodFree text: Just got the shot 10 minutes ago. On 1st shot the next day I was sick for 8 hours probably because I had Covid-19 in April- May 2019MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-04
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Vomiting, Diarrhea · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
- 2021-03-05
- 2021-03-07
- 2021-03-08
- 2021-03-09
- 2021-03-10
- 2021-03-18
- 2021-03-26
- 2021-04-01
- 2021-04-07
-
2021-04-15
Survey response — day 42, dose 2MedDRA: Feeling abnormal, Telemedicine — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultationFree text: Symptoms: ever since having Covid 19 in April May 2020 I have had a couch that emanates from my throat, not my chest. I can't seem to get rid of it. Also for the last 8 or so months, I have had fog feeling in my brain. · Healthcare visit (other): telehealth with neurologist today and primary doctor appointment on May 4MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-15
Report sent to call center — day 42, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-04
-
2022-02-21
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-03-05
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-03 | Moderna | |
| 2 | 2021-03-03 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 4 — day 7, dose 1
Systemic reaction (other): This happened on Feb 4 and better on the 5th
Release 5 — day 0, dose 2
Systemic reaction (other): Just got the shot 10 minutes ago. On 1st shot the next day I was sick for 8 hours probably because I had Covid-19 in April- May 2019
Release 7 — day 42, dose 2
Symptoms: ever since having Covid 19 in April May 2020 I have had a couch that emanates from my throat, not my chest. I can't seem to get rid of it. Also for the last 8 or so months, I have had fog feeling in my brain.
Healthcare visit (other): telehealth with neurologist today and primary doctor appointment on May 4
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 | Telemedicine | ✓ | ✓ | ✓ |
| SD | Feeling abnormal | ✓ | ✓ | ✓ |
| SRO | Adverse reaction | · | · | ✓ |
| SRO | COVID-19 | ✓ | ✓ | ○ |
| SRO | Malaise | · | · | ✓ |
| SRO | No adverse event | ✓ | ✓ | ○ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release