452-16254-47334
2 vaccinations
4 coded responses
28 check-ins
4 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 302 / GA
- Registered
- 2021-01-22
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-22
Registered in v-safe
-
2021-01-22
Dose 1 — Moderna
- 2021-01-22
-
2021-01-23
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-01-24
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-01-25
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-01-26
- 2021-01-27
- 2021-01-28
- 2021-01-29
- 2021-02-05
-
2021-02-12
Survey response — day 21, dose 1MedDRA: Fatigue — Feeling: FairFree text: Very tiredMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-19
- 2021-02-26
-
2021-03-05
Dose 2 — Moderna
-
2021-03-05
Health check-in — day 0, dose 2Feeling: Good · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-06
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2021-03-07
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-03-08
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-03-09
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-03-10
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-11
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-03-12
Health check-in — day 7, dose 2Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2021-03-22
- 2021-03-27
- 2021-04-02
- 2021-04-09
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2021-04-17
Survey response — day 42, dose 2MedDRA: Cardiac failure, Gait disturbance, Irritability — Feeling: FairFree text: He already has heart failure and just seems more irritable and unstable in his feet. He had an echo and we go in for the results Monday. Not new problems just standard check ups.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-04
Survey response — 3 months, dose 2MedDRA: Blood glucose increased, Diabetes mellitus inadequate control, International normalised ratio decreased — Feeling: Poor · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit, Emergency room or emergency department visitFree text: INR is going down blood sugar is high unstable and fallingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-04
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-05
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2021-12-17
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
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2022-03-05
Survey response — 12 months, dose 2MedDRA: COVID-19, Death, Hospice care, Hospitalisation, Pre-existing disease — Feeling: Poor · Get care from a doctor or other healthcare professional · HospitalizationFree text: Symptoms: My husband (b)(6) contracted Covid in January and died due to the infection and his underlying heart and health conditions. · Healthcare visit (other): Hospitalization and hospice care.MedDRA releases: 2024-11 · check-in free text available
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2022-03-05
Report sent to call center — 12 months, dose 2Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
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2022-03-08
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-03-05 | Moderna |
Call center
2 call center cases
2 successful
Free text
Release 4 — day 21, dose 1
Symptoms: Very tired
Release 7 — day 42, dose 2
Symptoms: He already has heart failure and just seems more irritable and unstable in his feet. He had an echo and we go in for the results Monday. Not new problems just standard check ups.
Release 8 — 3 months, dose 2
Symptoms: INR is going down blood sugar is high unstable and falling
Release 11 — 12 months, dose 2
Reports this person's death
Symptoms: My husband (b)(6) contracted Covid in January and died due to the infection and his underlying heart and health conditions.
Healthcare visit (other): Hospitalization and hospice care.
redacted (b)(6)
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 | Hospice care | · | · | ✓ |
| HCVO | Hospitalisation | · | · | ✓ |
| SD | Blood glucose increased | ✓ | ✓ | ✓ |
| SD | Cardiac failure | ✓ | ✓ | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Death | · | · | ✓ |
| SD | Diabetes mellitus inadequate control | ✓ | ✓ | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Gait disturbance | ✓ | ✓ | ✓ |
| SD | International normalised ratio decreased | ✓ | ✓ | ✓ |
| SD | Irritability | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release