47K-30930-58924
3 vaccinations
12 coded responses
41 check-ins
12 free-text entries
6 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 930 / CA
- Registered
- 2021-03-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Hispanic or Latino
Timeline
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2021-03-12
Registered in v-safe
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2021-03-12
Dose 1 — Moderna
- 2021-03-12
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2021-03-13
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Headache, Fatigue or tirednessAdult check-in
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
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2021-04-02
Survey response — day 21, dose 1MedDRA: Pain — Feeling: FairFree text: Pain in left side like pneumonia. Or maybe a kidney stone.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-09
Dose 2 — Moderna
- 2021-04-09
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2021-04-10
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-04-11
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Fair · Site: Pain · Headache, Joint pains, Fatigue or tirednessFree text: DizzyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-12
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Joint pains, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-04-13
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Fair · Joint pains, DiarrheaFree text: DizzyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-14
Survey response — days 1–6 daily, dose 2MedDRA: Insomnia — Feeling: Good · Headache, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesFree text: Sleeplessness. Awake many hours during the night.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-15
Survey response — days 1–6 daily, dose 2MedDRA: Dizziness — Feeling: Fair · Joint pains, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesFree text: DizzinessMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-16
Survey response — day 7, dose 2MedDRA: Insomnia, Pollakiuria, Sleep disorder, Unevaluable event — Feeling: Poor · Fever · Chills, Joint pains, Fatigue or tiredness, Diarrhea · Be unable to do your normal daily activitiesFree text: Up most of night and bathroom every 20 minutes.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-23
Survey response — day 14, dose 2MedDRA: Diarrhoea, Hospitalisation, Pre-existing disease — Feeling: Fair · Be unable to work, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, HospitalizationFree text: Diarrhea with total kidney failure. 3 days in hospital and massive amounts of fluids to get them started again. No reason found for the diarrhea. Still seeing uraligest and Gastro doctors.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 14, dose 2Be unable to work · Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-04-30
- 2021-05-08
- 2021-05-14
- 2021-05-21
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2021-07-09
Survey response — 3 months, dose 2MedDRA: Dyspnoea, Unevaluable event — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Shortness of breath · Healthcare visit (other): Primary docMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-07-09
Report sent to call center — 3 months, dose 2Get care from a doctor or other healthcare professional1 call case(s)
- 2021-07-13
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2021-07-14
Call successfulDoes not wish to fill out VAERS report
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2021-10-08
Survey response — 6 months, dose 2MedDRA: Condition aggravated, Pre-existing disease, Pulmonary mass — Feeling: Fair · Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Cysts on liver growing and mass in upper right lungMedDRA releases: 2024-11 · check-in free text available
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2021-10-08
Report sent to call center — 6 months, dose 2Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2021-10-11
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2021-10-12
Call successfulCompleted over the phone
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2021-11-11
Dose 3 — Moderna
- 2021-11-11
- 2021-11-12
- 2021-11-13
- 2021-11-14
- 2021-11-15
- 2021-11-16
- 2021-11-17
- 2021-11-18
- 2021-11-25
- 2021-12-02
- 2021-12-09
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2021-12-16
Survey response — day 35, dose 3MedDRA: Blood pressure abnormal — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Having trouble controlling blood pressureMedDRA releases: 2024-11 · check-in free text available
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2021-12-16
Report sent to call center — day 35, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2021-12-18
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2021-12-23
Survey response — day 42, dose 3MedDRA: Atrial fibrillation, Blood pressure abnormal, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Blood pressure and a-fib acting upMedDRA releases: 2024-11 · check-in free text available
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2021-12-23
Report sent to call center — day 42, dose 3Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
- 2021-12-27
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2021-12-29
Call successfulDoes not wish to fill out VAERS report
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2022-02-10
Survey response — 3 months, dose 3MedDRA: Atrial fibrillation, Office visit, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: My a-fib was acting up and my cardiologist adjusted my meds. · Healthcare visit (other): Doctor visit and ekg done.MedDRA releases: 2024-11 · check-in free text available
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2022-02-10
Report sent to call center — 3 months, dose 3Get care from a doctor or other healthcare professional1 call case(s)
- 2022-02-15
- 2022-02-17
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2022-02-18
Call successfulDoes not wish to fill out VAERS report
- 2022-05-12
- 2022-11-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-12 | Moderna | |
| 2 | 2021-04-09 | Moderna | |
| 3 | 2021-11-11 | Moderna | No |
Call center
6 call center cases
6 successful
VAERS report filed, before or during a call: 1
Free text
Release 6 — day 21, dose 1
Symptoms: Pain in left side like pneumonia. Or maybe a kidney stone.
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Dizzy
Systemic reaction (other): Dizzy
Systemic reaction (other): Sleeplessness. Awake many hours during the night.
Systemic reaction (other): Dizziness
Release 7 — day 7, dose 2
Systemic reaction (other): Up most of night and bathroom every 20 minutes.
Release 7 — day 14, dose 2
Symptoms: Diarrhea with total kidney failure. 3 days in hospital and massive amounts of fluids to get them started again. No reason found for the diarrhea. Still seeing uraligest and Gastro doctors.
Release 9 — 3 months, dose 2
Release 10 — 6 months, dose 2
Symptoms: Cysts on liver growing and mass in upper right lung
Release 10 — day 35, dose 3
Symptoms: Having trouble controlling blood pressure
Release 10 — day 42, dose 3
Symptoms: Blood pressure and a-fib acting up
Release 11 — 3 months, dose 3
Symptoms: My a-fib was acting up and my cardiologist adjusted my meds.
Healthcare visit (other): Doctor visit and ekg done.
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 | Atrial fibrillation | · | · | ✓ |
| SD | Blood pressure abnormal | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Diarrhoea | ✓ | ✓ | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Pulmonary mass | · | · | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
| SRO | Pollakiuria | ✓ | ✓ | ○ |
| SRO | Sleep disorder | · | · | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release