4NJ-52660-87753
2 vaccinations
6 coded responses
26 check-ins
6 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 662 / KS
- Registered
- 2021-03-08
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-08
Registered in v-safe
-
2021-03-08
Dose 1 — Moderna
-
2021-03-08
Survey response — day 0, dose 1MedDRA: No adverse event — Feeling: Good · HeadacheFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-09
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: Good · Site: Pain · Muscle or body achesFree text: NoneMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-10
- 2021-03-11
- 2021-03-12
-
2021-03-13
Survey response — days 1–6 daily, dose 1MedDRA: No adverse event — Feeling: Good · Fatigue or tirednessFree text: NoMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-14
- 2021-03-15
- 2021-03-22
- 2021-03-29
-
2021-04-05
Dose 2 — Moderna
- 2021-04-05
-
2021-04-06
Survey response — days 1–6 daily, dose 2MedDRA: Hypertonic bladder, Pollakiuria, Pre-existing disease, Renal disorder — Feeling: Fair · Site: Pain · Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea, Diarrhea, Abdominal pain · Be unable to workFree text: This morning I urinated about 10 times in 3 hours. I had drank 2 glasses of water during night 2. Cups of coffee and 2 small gratorades. I have an overactive bladder but that much. I have stage 3 kidney disease. Also.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-07
- 2021-04-08
- 2021-04-09
-
2021-04-10
Survey response — days 1–6 daily, dose 2MedDRA: Pain — Feeling: Fair · Abdominal painFree text: Pain is not from vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-11
- 2021-04-12
- 2021-04-19
- 2021-04-26
- 2021-05-03
- 2021-05-10
- 2021-05-17
- 2021-07-05
- 2021-10-04
-
2022-04-05
Survey response — 12 months, dose 2MedDRA: Fatigue, Headache, SARS-CoV-2 test negative, SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Tested positive for Covid this is first day of testing negative. Very mild symptoms: mild headache at times; no temperature; no digestive issues; some fatigue but I worked everyday (except days that it rained) outside in my garden.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-05
Report sent to call center — 12 months, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
- 2022-04-12
-
2022-04-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-08 | Moderna | |
| 2 | 2021-04-05 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 5 — day 0, dose 1
Systemic reaction (other): No
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): None
Systemic reaction (other): No
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): This morning I urinated about 10 times in 3 hours. I had drank 2 glasses of water during night 2. Cups of coffee and 2 small gratorades. I have an overactive bladder but that much. I have stage 3 kidney disease. Also.
Systemic reaction (other): Pain is not from vaccine
Release 11 — 12 months, dose 2
Symptoms: Tested positive for Covid this is first day of testing negative. Very mild symptoms: mild headache at times; no temperature; no digestive issues; some fatigue but I worked everyday (except days that it rained) outside in my garden.
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 | Fatigue | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Hypertonic bladder | ○ | ✓ | ○ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Pollakiuria | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | · | ✓ |
| SRO | Renal disorder | ○ | ✓ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release