4AJ-29591-28229
2 vaccinations
4 coded responses
22 check-ins
4 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 347 / FL
- Registered
- 2021-03-09
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-08
Dose 1 — Moderna
-
2021-03-09
Registered in v-safe
-
2021-03-09
Survey response — days 1–6 daily, dose 1MedDRA: Heart rate increased — Feeling: GoodFree text: Elevated pulse for two hours. 82 instead of normal 65.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-10
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-22
- 2021-03-29
-
2021-04-12
Survey response — day 35, dose 1MedDRA: Hospitalisation — Feeling: GoodFree text: Hospitalized two weeks ago with non-Covid related problem. Getting my second Moderna shot Thursday evening.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-15
Dose 2 — Moderna
-
2021-04-19
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-20
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-04-21
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
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2021-04-22
Survey response — day 7, dose 2MedDRA: Fatigue — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Most of the fatigue has dissipated, getting back to normal.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-29
-
2021-05-06
Survey response — day 21, dose 2MedDRA: Asthenia, Chills, Pyrexia — Feeling: Poor · 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: Monday night fever and violent shivering. Total loss of energy since. This is the third time since my first shot. Spent four days in hospital late March. Two more events since my second shot May 17.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-06
Report sent to call center — day 21, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-05-13
- 2021-05-21
- 2021-05-27
- 2021-07-15
- 2021-10-14
-
2022-01-05
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-04-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-08 | Moderna | |
| 2 | 2021-04-15 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): Elevated pulse for two hours. 82 instead of normal 65.
Release 7 — day 35, dose 1
Symptoms: Hospitalized two weeks ago with non-Covid related problem. Getting my second Moderna shot Thursday evening.
Release 7 — day 7, dose 2
Systemic reaction (other): Most of the fatigue has dissipated, getting back to normal.
Release 8 — day 21, dose 2
Symptoms: Monday night fever and violent shivering. Total loss of energy since. This is the third time since my first shot. Spent four days in hospital late March. Two more events since my second shot May 17.
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 | Asthenia | ✓ | ✓ | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Hospitalisation | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Heart rate increased | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release