4PJ-10624-24434
4 vaccinations
3 coded responses
16 check-ins
3 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 804 / CO
- Registered
- 2021-03-29
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-22
Dose 1 — Moderna
-
2021-02-19
Dose 2 — Moderna
-
2021-03-29
Registered in v-safe
- 2021-03-29
- 2021-04-02
- 2021-05-23
- 2021-08-20
-
2021-11-24
Dose 3 — Moderna
- 2022-02-19
- 2022-02-23
-
2022-05-25
Dose 4 — Moderna
-
2022-05-27
Survey response — 6 months, dose 3MedDRA: Condition aggravated, Pre-existing disease — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Prostrate problems were exacerbated since COVID delta late November 2021. Could be attributed to taking theraflu.MedDRA releases: 2024-11 · check-in free text available
-
2022-05-27
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalEmergency room or emergency department visit · 1 call case(s)
-
2022-05-29
Health check-in — days 1–6 daily, dose 4Feeling: Good · Joint pains, Muscle or body achesAdult check-in
-
2022-05-30
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Muscle or body aches, Fatigue or tirednessAdult check-in
- 2022-05-31
-
2022-06-01
Survey response — day 7, dose 4MedDRA: Asthenia, COVID-19, Fatigue, Pre-existing disease — Feeling: Fair · Fatigue or tirednessFree text: The fatigue and tiredness are normal. I am 76 yo with a number of pre-existing health difficulties. And did not regain strength after Delta Covid episode end of October 2021.MedDRA releases: 2024-11 · check-in free text available
- 2022-06-08
- 2022-06-15
- 2022-07-06
- 2022-08-25
-
2022-11-23
Survey response — 6 months, dose 4MedDRA: Bacterial infection, Endotracheal intubation, Feeding tube user, Hospitalisation, Intensive care, Respiratory failure, Respiratory syncytial virus infection, Sepsis — Feeling: Poor · Be unable to work or attend school, 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: Respiratory failure and sepsis on 11/19. RSV virus and bacterial infection. Still in ICU on breathing and feeding tubes.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-23
Report sent to call center — 6 months, dose 4Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prEmergency room or emergency department visit · Hospitalization · 1 call case(s)
- 2022-11-25
- 2022-11-25
- 2023-05-25
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-02-19 | Moderna | |
| 3 | 2021-11-24 | Moderna | No |
| 4 | 2022-05-25 | Moderna | No |
Call center
2 call center cases
2 unsuccessful
Free text
Release 11 — 6 months, dose 3
Symptoms: Prostrate problems were exacerbated since COVID delta late November 2021. Could be attributed to taking theraflu.
Release 11 — day 7, dose 4
Systemic reaction (other): The fatigue and tiredness are normal. I am 76 yo with a number of pre-existing health difficulties. And did not regain strength after Delta Covid episode end of October 2021.
Release 12 — 6 months, dose 4
Symptoms: Respiratory failure and sepsis on 11/19. RSV virus and bacterial infection. Still in ICU on breathing and feeding tubes.
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 | Bacterial infection | · | · | ✓ |
| SD | Condition aggravated | · | · | ✓ |
| SD | Endotracheal intubation | · | · | ✓ |
| SD | Feeding tube user | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Intensive care | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Respiratory failure | · | · | ✓ |
| SD | Respiratory syncytial virus infection | · | · | ✓ |
| SD | Sepsis | · | · | ✓ |
| SRO | Asthenia | · | · | ✓ |
| SRO | COVID-19 | · | · | ✓ |
| SRO | Fatigue | · | · | ✓ |
| SRO | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release