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4KU-29372-60980

2 vaccinations 5 coded responses 26 check-ins 5 free-text entries 0 call cases
Sex
Male
Age at first dose
21-25
ZIP prefix
781 / TX
Registered
2021-03-01
Relationship
Self
Race
White
Ethnicity
Hispanic or Latino

Timeline

  1. 2021-03-01
    Registered in v-safe
  2. 2021-03-01
    Dose 1 — Moderna
  3. 2021-03-01
    Survey response — day 0, dose 1
    MedDRA: Injection site pain — Feeling: Fair · Site: Pain
    Free text: Pain/soreness on injection arm, left arm.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  4. 2021-03-02
    Survey response — days 1–6 daily, dose 1
    MedDRA: Arthralgia, Pain in extremity — Feeling: Fair · Site: Pain · Muscle or body aches
    Free text: Soreness on left arm and shoulders
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-03
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  6. 2021-03-04
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-03-05
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  8. 2021-03-06
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-03-07
    Survey response — days 1–6 daily, dose 1
    MedDRA: Pain in extremity, Pre-existing disease — Feeling: Good
    Free text: It is unknown if the pain (b)(6) has been having in his arms is due to the vaccine since he is a stroke patient.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-03-08
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-03-15
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-03-22
    Survey response — day 21, dose 1
    MedDRA: Body temperature increased, Cough, Diarrhoea, Emergency care, Pneumonia — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Developed cough and temperature ranging from 100°F-105°. Was admited to (b)(6) ER overnight and treated for pneumonia. Was prescribed antibiotics and currently have diarrhea probably due to antibiotics. Not sure if related to vaccine. No COVID.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-03-29
    Dose 2 — Moderna
  14. 2021-03-29
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  15. 2021-03-30
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Site: Swelling · Fever · None
    Adult check-in
  16. 2021-03-31
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Swelling · None
    Adult check-in
  17. 2021-04-01
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Swelling · None
    Adult check-in
  18. 2021-04-02
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  19. 2021-04-03
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Fever · None
    Adult check-in
  20. 2021-04-04
    Health check-in — days 1–6 daily, dose 2
    Feeling: Fair · Fever · None
    Adult check-in
  21. 2021-04-05
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  22. 2021-04-12
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-04-19
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  24. 2021-04-26
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  25. 2021-05-03
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  26. 2021-05-10
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  27. 2021-06-29
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  28. 2021-09-27
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  29. 2022-03-31
    Survey response — 12 months, dose 2
    MedDRA: Emergency care, SARS-CoV-2 test positive, Seizure like phenomena — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities
    Free text: 1 March, 2022, Had siezure like activity was taken to ER. They did a COVID test and results were positive.
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-03-01Moderna
22021-03-29Moderna

Free text

Release 4 — day 0, dose 1

2021-03-01

Systemic reaction (other): Pain/soreness on injection arm, left arm.

Release 4 — days 1–6 daily, dose 1

2021-03-02

Systemic reaction (other): Soreness on left arm and shoulders

Release 5 — days 1–6 daily, dose 1

2021-03-07

Systemic reaction (other): It is unknown if the pain (b)(6) has been having in his arms is due to the vaccine since he is a stroke patient.
redacted (b)(6)

Release 6 — day 21, dose 1

2021-03-22

Symptoms: Developed cough and temperature ranging from 100°F-105°. Was admited to (b)(6) ER overnight and treated for pneumonia. Was prescribed antibiotics and currently have diarrhea probably due to antibiotics. Not sure if related to vaccine. No COVID.
redacted (b)(6)

Release 11 — 12 months, dose 2

2022-03-31

Symptoms: 1 March, 2022, Had siezure like activity was taken to ER. They did a COVID test and results were positive.

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

FieldPreferred term2021-092023-042024-11
SDBody temperature increased ✓ ✓ ✓
SDCough ✓ ✓ ✓
SDDiarrhoea ✓ ✓ ✓
SDEmergency care ✓ ✓ ✓
SDPneumonia ✓ ✓ ✓
SDSARS-CoV-2 test positive · · ✓
SDSeizure like phenomena · · ✓
SROArthralgia ✓ ✓ ✓
SROInjection site pain ✓ ✓ ✓
SROPain in extremity ✓ ✓ ✓
SROPre-existing disease ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release

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