3ZJ-20264-21953
2 vaccinations
6 coded responses
25 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 41-45
- ZIP prefix
- 277 / NC
- Registered
- 2021-03-17
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-16
Dose 1 — Moderna
-
2021-03-17
Registered in v-safe
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2021-03-17
Survey response — days 1–6 daily, dose 1MedDRA: Conjunctivitis — Feeling: Fair · Site: PainFree text: ConjunctivitisMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-18
Survey response — days 1–6 daily, dose 1MedDRA: Conjunctivitis — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Pink Eye . Eye is same side of body as shot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-18
Report sent to call center — days 1–6 daily, dose 1Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-03-19
Survey response — days 1–6 daily, dose 1MedDRA: Conjunctivitis — Feeling: Fair · Be unable to workFree text: Lingering conjunctivitis not improving with tobramycin dropsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-20
Survey response — days 1–6 daily, dose 1MedDRA: Conjunctivitis — Feeling: GoodFree text: First eye is better, second isnt. May be a coincidence but havent had conjunctivitis since I was 6.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-04-01
- 2021-04-06
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2021-04-16
Dose 2 — Moderna
- 2021-04-16
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2021-04-17
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain, Swelling · Fever · Chills, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-04-18
Survey response — days 1–6 daily, dose 2MedDRA: Injection site erythema — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection siteFree text: Redness starting just below the injection site has spread down to the elbow.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-19
Survey response — days 1–6 daily, dose 2MedDRA: Arthralgia, Rash, Self-medication, Sleep disorder — Feeling: Fair · Site: Pain, Redness, Swelling · Joint pains, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection siteFree text: Rash now down to the elbow. Shoulder pain woke me up, difficult to get back to sleep. It was better during the day due to 800mg Ibuprofen.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-20
Health check-in — days 1–6 daily, dose 2Feeling: Good · Joint pains, Muscle or body achesAdult check-in
- 2021-04-21
- 2021-04-22
- 2021-04-25
- 2021-04-30
- 2021-05-07
- 2021-05-14
- 2021-05-21
- 2021-05-29
- 2021-07-16
- 2021-10-16
- 2022-03-03
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2022-03-08
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-04-16
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-16 | Moderna | |
| 2 | 2021-04-16 | Moderna |
Call center
1 call center case
1 successful
1 wait over 3 months for a first call
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Conjunctivitis
Systemic reaction (other): Pink Eye . Eye is same side of body as shot.
Systemic reaction (other): Lingering conjunctivitis not improving with tobramycin drops
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): First eye is better, second isnt. May be a coincidence but havent had conjunctivitis since I was 6.
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Redness starting just below the injection site has spread down to the elbow.
Systemic reaction (other): Rash now down to the elbow. Shoulder pain woke me up, difficult to get back to sleep. It was better during the day due to 800mg Ibuprofen.
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 |
|---|---|---|---|---|
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Conjunctivitis | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | ✓ | ✓ | ✓ |
| SRO | Rash | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Sleep disorder | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release