48W-96975-25551
1 vaccination
4 coded responses
9 check-ins
4 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 852 / AZ
- Registered
- 2021-03-01
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-01
Registered in v-safe
-
2021-03-01
Dose 1 — Moderna
- 2021-03-07
-
2021-03-08
Health check-in — day 7, dose 1Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-15
- 2021-03-22
- 2021-03-29
-
2021-04-05
Survey response — day 35, dose 1MedDRA: Asthenia, Pain — Feeling: FairFree text: No energy, body acheMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-05-31
Survey response — 3 months, dose 1MedDRA: Arthritis, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Arthritis has flared up.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-08-30
Survey response — 6 months, dose 1MedDRA: Cardiac operation, Home care, Hospitalisation, Physiotherapy, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: I had a heart proceedure to remove wire that held my rib cage together after open heart surgery in2015. The wire were surfacing.. in hospital 24 hr. Stitches to be removed 9/12. Have Kendal Home Health nurses and pt. · Healthcare visit (other): (b)(6) Home Health CareMedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-08-30
Report sent to call center — 6 months, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-09-07
-
2022-03-01
Survey response — 12 months, dose 1MedDRA: Fall, Office visit, Rib fracture, Skin laceration — Feeling: Fair · Get care from a doctor or other healthcare professionalFree text: Symptoms: Fell and broke 5th rib plus skin tears. · Healthcare visit (other): Went to my spots ortho Dr who saw me at 8am the day after I called, they condidered it a emergency visit for a known patient.MedDRA releases: 2024-11 · check-in free text available
-
2022-03-01
Report sent to call center — 12 months, dose 1Get care from a doctor or other healthcare professional1 call case(s)
- 2022-03-02
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-01 | Moderna |
Call center
2 call center cases
2 unsuccessful
Free text
Release 6 — day 35, dose 1
Symptoms: No energy, body ache
Release 8 — 3 months, dose 1
Symptoms: Arthritis has flared up.
Release 9 — 6 months, dose 1
Symptoms: I had a heart proceedure to remove wire that held my rib cage together after open heart surgery in2015. The wire were surfacing.. in hospital 24 hr. Stitches to be removed 9/12. Have Kendal Home Health nurses and pt.
Healthcare visit (other): (b)(6) Home Health Care
redacted (b)(6)
Release 11 — 12 months, dose 1
Symptoms: Fell and broke 5th rib plus skin tears.
Healthcare visit (other): Went to my spots ortho Dr who saw me at 8am the day after I called, they condidered it a emergency visit for a known patient.
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 | Home care | ✓ | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Arthritis | ✓ | ✓ | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Cardiac operation | ✓ | · | ✓ |
| SD | Fall | · | · | ✓ |
| SD | Home care | ✓ | · | ✓ |
| SD | Hospitalisation | ✓ | · | ✓ |
| SD | Pain | ✓ | ✓ | ✓ |
| SD | Physiotherapy | ✓ | · | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Rib fracture | · | · | ✓ |
| SD | Skin laceration | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release