3YD-20127-64637
3 vaccinations
8 coded responses
37 check-ins
8 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 197 / DE
- Registered
- 2021-01-18
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-18
Registered in v-safe
-
2021-01-18
Dose 1 — Moderna
- 2021-01-18
-
2021-01-19
Survey response — days 1–6 daily, dose 1MedDRA: Dizziness — Feeling: Good · Site: Pain, Swelling · Chills, Muscle or body achesFree text: DizzynessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-20
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain, Swelling · ChillsAdult check-in
- 2021-01-22
- 2021-01-23
- 2021-01-24
- 2021-01-25
- 2021-02-01
- 2021-02-08
- 2021-02-15
-
2021-02-21
Dose 2 — Moderna
- 2021-02-22
-
2021-02-23
Health check-in — days 1–6 daily, dose 2Feeling: Good · Chills, Fatigue or tirednessAdult check-in
- 2021-02-24
- 2021-02-25
- 2021-02-26
- 2021-02-27
- 2021-02-28
- 2021-03-07
- 2021-03-14
- 2021-03-21
- 2021-03-28
-
2021-04-04
Survey response — day 42, dose 2MedDRA: Food allergy — Feeling: GoodFree text: Food sensativity.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-23
Survey response — 3 months, dose 2MedDRA: Gout, Pain in extremity — Feeling: Good · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: Gout or other feet problemsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-23
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-22
-
2021-11-01
Dose 3 — Moderna
-
2021-11-02
Survey response — days 1–6 daily, dose 3MedDRA: Peripheral swelling — Feeling: Fair · Fatigue or tirednessFree text: Very slight swelling of fingers and toesMedDRA releases: 2024-11 · check-in free text available
- 2021-11-03
-
2021-11-04
Survey response — days 1–6 daily, dose 3MedDRA: Peripheral swelling, Pruritus — Feeling: Good · Rash, not including the immediate area around the injection siteFree text: 2 or 3 hours of very slight toe swelling and foot itchingMedDRA releases: 2024-11 · check-in free text available
-
2021-11-06
Survey response — days 1–6 daily, dose 3MedDRA: Hypoaesthesia — Feeling: Fair · Fatigue or tirednessFree text: Numbness in legs and hands at nightMedDRA releases: 2024-11 · check-in free text available
-
2021-11-07
Survey response — days 1–6 daily, dose 3MedDRA: Hypoaesthesia — Feeling: Good · Fatigue or tirednessFree text: Numbness of feet while sleepingMedDRA releases: 2024-11 · check-in free text available
- 2021-11-08
- 2021-11-16
- 2021-11-22
- 2021-11-29
- 2021-12-06
-
2021-12-13
Survey response — day 42, dose 3MedDRA: Diarrhoea, Frequent bowel movements, Mouth swelling, Pollakiuria, Swollen tongue — Feeling: GoodFree text: Frequent bowel movements and urinating, along with one time extreme diarrhea. Very frequent eliminations were for about 3 days. slight swelling of mouth and tongue. No other symptoms ended after about 4 or 5 days.MedDRA releases: 2024-11 · check-in free text available
- 2022-01-31
-
2022-02-16
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-05-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-18 | Moderna | |
| 2 | 2021-02-21 | Moderna | |
| 3 | 2021-11-01 | Moderna | No |
Call center
1 call center case
1 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Dizzyness
Release 6 — day 42, dose 2
Symptoms: Food sensativity.
Release 8 — 3 months, dose 2
Symptoms: Gout or other feet problems
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Very slight swelling of fingers and toes
Systemic reaction (other): 2 or 3 hours of very slight toe swelling and foot itching
Systemic reaction (other): Numbness in legs and hands at night
Systemic reaction (other): Numbness of feet while sleeping
Release 10 — day 42, dose 3
Symptoms: Frequent bowel movements and urinating, along with one time extreme diarrhea. Very frequent eliminations were for about 3 days. slight swelling of mouth and tongue. No other symptoms ended after about 4 or 5 days.
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 | Diarrhoea | · | · | ✓ |
| SD | Food allergy | ✓ | ✓ | ✓ |
| SD | Frequent bowel movements | · | · | ✓ |
| SD | Gout | ✓ | ✓ | ✓ |
| SD | Mouth swelling | · | · | ✓ |
| SD | Pain in extremity | ✓ | ✓ | ✓ |
| SD | Pollakiuria | · | · | ✓ |
| SD | Swollen tongue | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Hypoaesthesia | · | · | ✓ |
| SRO | Peripheral swelling | · | · | ✓ |
| SRO | Pruritus | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release