3XM-11279-49493
4 vaccinations
13 coded responses
39 check-ins
13 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 077 / NJ
- Registered
- 2021-02-28
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-26
Dose 1 — Moderna
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2021-02-28
Registered in v-safe
- 2021-02-28
- 2021-03-01
- 2021-03-02
- 2021-03-03
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2021-03-04
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Fatigue or tiredness, DiarrheaAdult check-in
- 2021-03-05
- 2021-03-12
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2021-03-19
Survey response — day 21, dose 1MedDRA: Arthralgia, Hip arthroplasty — Feeling: GoodFree text: Pain in left hip. Probably fraying. Dr told me that was the case in 2018 before replacing right hip.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-26
Dose 2 — Moderna
- 2021-03-26
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2021-03-28
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Pre-existing disease — Feeling: Fair · Site: Pain · Abdominal painFree text: Pain in left hip area, at least moderate, maybe worse but probably not related to the shot. Possible fraying of the hip, similar to pain in right hip before replacement in 2018.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-29
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia — Feeling: Good · Site: Pain · Abdominal painFree text: Same pain in in left hip as I have had for 2 or 3 weeks. Probably not related to injections.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-30
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia — Feeling: Good · Site: Pain · Abdominal painFree text: Pain in left hip continues. Have continued to do my daily walk, but hip is tight and painful though probably has nothing to do with pandemic or shots.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-31
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia — Feeling: Good · Site: Pain · Abdominal painFree text: Left hip pain continues unrelated to shots.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-01
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia — Feeling: Good · Site: Pain · Abdominal painFree text: Same pain in left hip, probably not related to shots.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-03
Survey response — day 7, dose 2MedDRA: Arthralgia — Feeling: Good · Site: Pain · Abdominal painFree text: Same hip pain as before.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-09
Survey response — day 14, dose 2MedDRA: Arthralgia, Office visit — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: I am feeling the same pain in my left hip, but it is worse. Do not believe it is Covid related, but nevertheless it is painful. · Healthcare visit (other): Chiropractor. Also have appointment with orthopedist but not till 5/18zMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-09
Report sent to call center — day 14, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-16
Survey response — day 21, dose 2MedDRA: Arthralgia — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Continuous pain in left hip. Getting worse. Probably not related to shots, but appointment for next month with orthopedist.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-23
Survey response — day 28, dose 2MedDRA: Arthralgia, Unevaluable event — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Severe pain in left hip. Appointments with orthopedists for 4/29 and 5/18. Probably fraying of the hip due to age. · Healthcare visit (other): Appointments start next week.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-23
Report sent to call center — day 28, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-30
- 2021-05-07
- 2021-06-25
- 2021-09-24
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2021-11-01
Dose 3 — Moderna
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2021-11-01
Survey response — day 0, dose 3MedDRA: Psoriasis — Feeling: GoodFree text: Other than psoriasisMedDRA releases: 2024-11 · check-in free text available
- 2021-11-02
- 2021-11-04
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2021-11-05
Survey response — days 1–6 daily, dose 3MedDRA: Psoriasis — Feeling: GoodFree text: Other than psoriasisMedDRA releases: 2024-11 · check-in free text available
- 2021-11-06
- 2021-11-07
- 2021-11-11
- 2021-11-15
- 2021-11-22
- 2021-11-29
- 2021-12-06
- 2021-12-15
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2022-01-31
Survey response — 3 months, dose 3MedDRA: Cough, Nasopharyngitis, SARS-CoV-2 test negative — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Cough and cold, not Covid, was testedMedDRA releases: 2024-11 · check-in free text available
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2022-01-31
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-02-01
- 2022-05-02
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2022-11-04
Dose 4 — Moderna
- 2022-11-04
- 2023-02-03
- 2023-05-07
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-26 | Moderna | |
| 2 | 2021-03-26 | Moderna | |
| 3 | 2021-11-01 | Moderna | No |
| 4 | 2022-11-04 | Moderna | No |
Call center
3 call center cases
3 unsuccessful
Free text
Release 5 — day 21, dose 1
Symptoms: Pain in left hip. Probably fraying. Dr told me that was the case in 2018 before replacing right hip.
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): Pain in left hip area, at least moderate, maybe worse but probably not related to the shot. Possible fraying of the hip, similar to pain in right hip before replacement in 2018.
Systemic reaction (other): Same pain in in left hip as I have had for 2 or 3 weeks. Probably not related to injections.
Systemic reaction (other): Pain in left hip continues. Have continued to do my daily walk, but hip is tight and painful though probably has nothing to do with pandemic or shots.
Systemic reaction (other): Left hip pain continues unrelated to shots.
Systemic reaction (other): Same pain in left hip, probably not related to shots.
Release 6 — day 7, dose 2
Systemic reaction (other): Same hip pain as before.
Release 7 — day 14, dose 2
Symptoms: I am feeling the same pain in my left hip, but it is worse. Do not believe it is Covid related, but nevertheless it is painful.
Healthcare visit (other): Chiropractor. Also have appointment with orthopedist but not till 5/18z
Release 7 — day 21, dose 2
Symptoms: Continuous pain in left hip. Getting worse. Probably not related to shots, but appointment for next month with orthopedist.
Release 7 — day 28, dose 2
Symptoms: Severe pain in left hip. Appointments with orthopedists for 4/29 and 5/18. Probably fraying of the hip due to age.
Healthcare visit (other): Appointments start next week.
Release 10 — day 0, dose 3
Systemic reaction (other): Other than psoriasis
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Other than psoriasis
Release 11 — 3 months, dose 3
Symptoms: Cough and cold, not Covid, was tested
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 | ✓ | ✓ | ✓ |
| HCVO | Unevaluable event | ✓ | ✓ | ✓ |
| SD | Arthralgia | ✓ | ✓ | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Hip arthroplasty | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Psoriasis | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release