4JT-11269-03011
2 vaccinations
3 coded responses
19 check-ins
3 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 727 / AR
- 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
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-15
- 2021-03-22
-
2021-03-29
Dose 2 — Moderna
-
2021-03-29
Health check-in — day 0, dose 2Feeling: Fair · Site: Pain · Chills, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-03-30
Survey response — days 1–6 daily, dose 2MedDRA: Night sweats — Feeling: Poor · Site: Pain, Swelling · Fever · Chills, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesFree text: This morning, around 5:00 a.m. I awakened with my bedding sheets and my pillow heavily saturated in perspiration.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-31
Survey response — days 1–6 daily, dose 2MedDRA: Unevaluable event — Feeling: Fair · Site: Pain · Fatigue or tirednessFree text: 03/30/2021 Blood pressure 89/60, pulse range 150 - 159. Today blood pressure 103/80, pulse 101, appears to be normalizing. TodayMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-01
- 2021-04-02
- 2021-04-03
- 2021-04-04
- 2021-04-05
-
2021-06-28
Survey response — 3 months, dose 2MedDRA: Bell's palsy, Dry eye, Facial paralysis, Speech disorder — Feeling: PoorFree text: I have very recently, 06/25/2021, developed Bell's palsy on the left side of my face, of course with partial paralysis and a speech impediment and a dry left eye. Currently taking Prednisone and using a nighttime ophthalmic appointment for my left eyMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-01 | Moderna | |
| 2 | 2021-03-29 | Moderna |
Free text
Release 6 — days 1–6 daily, dose 2
Systemic reaction (other): This morning, around 5:00 a.m. I awakened with my bedding sheets and my pillow heavily saturated in perspiration.
Systemic reaction (other): 03/30/2021 Blood pressure 89/60, pulse range 150 - 159. Today blood pressure 103/80, pulse 101, appears to be normalizing. Today
Release 9 — 3 months, dose 2
Symptoms: I have very recently, 06/25/2021, developed Bell's palsy on the left side of my face, of course with partial paralysis and a speech impediment and a dry left eye. Currently taking Prednisone and using a nighttime ophthalmic appointment for my left ey cut off by CDC
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 | Bell's palsy | ✓ | ✓ | ✓ |
| SD | Dry eye | ✓ | ✓ | ✓ |
| SD | Facial paralysis | ✓ | ✓ | ✓ |
| SD | Speech disorder | ✓ | ✓ | ✓ |
| SRO | Night sweats | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release