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4RV-30432-02748

3 vaccinations 4 coded responses 26 check-ins 4 free-text entries 0 call cases
Sex
Male
Age at first dose
56-60
ZIP prefix
857 / AZ
Registered
2021-01-20
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-20
    Registered in v-safe
  2. 2021-01-20
    Dose 1 — Moderna
  3. 2021-01-20
    Health check-in — day 0, dose 1
    Feeling: Fair · Site: Pain · Fatigue or tiredness
    Adult check-in
  4. 2021-01-21
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · Muscle or body aches
    Adult check-in
  5. 2021-01-22
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Site: Pain · Joint pains
    Adult check-in
  6. 2021-01-23
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  7. 2021-01-24
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · Muscle or body aches
    Adult check-in
  8. 2021-01-25
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  9. 2021-01-26
    Health check-in — days 1–6 daily, dose 1
    Feeling: Good · None
    Adult check-in
  10. 2021-01-27
    Health check-in — day 7, dose 1
    Feeling: Good · None
    Adult check-in
  11. 2021-02-03
    Health check-in — day 14, dose 1
    Feeling: Good
    Adult check-in
  12. 2021-02-10
    Health check-in — day 21, dose 1
    Feeling: Good
    Adult check-in
  13. 2021-02-17
    Health check-in — day 28, dose 1
    Feeling: Good
    Adult check-in
  14. 2021-02-18
    Dose 2 — Moderna
  15. 2021-02-24
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  16. 2021-02-25
    Survey response — day 7, dose 2
    MedDRA: Dizziness, Fatigue, Impaired driving ability, Loss of consciousness, Pain, Pyrexia — Feeling: Good · Be unable to work, Be unable to do your normal daily activities
    Free text: I was repeatedly dizzy after my second vaccination. Approximately 1.5 hrs after that vaccination, I passed out and was woken by a woman who found me laying against my car steering wheel with the horn going off. (I had pulled over due to feeling dizzy). Dizziness and lightheadedness passed after about 5 hours. Fever, aches and fatigue followed and lasted about 24 hours. Then I felt fine. I did not receive this survey until several days after my second vaccination, and it only asks about thr previous 24 hour period. So I thought I would report it in this field..
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  17. 2021-03-04
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  18. 2021-03-11
    Survey response — day 21, dose 2
    MedDRA: Diarrhoea — Feeling: Good
    Free text: Diarrhea
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  19. 2021-03-18
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  20. 2021-03-27
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  21. 2021-04-03
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  22. 2021-05-20
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  23. 2021-08-19
    Survey response — 6 months, dose 2
    MedDRA: Diarrhoea, Pre-existing disease — Feeling: Good
    Free text: Diarrhea lasting about 2 weeks -- believed to be associated with Celiac Disease
    MedDRA releases: 2021-09,2024-11 · check-in free text available
  24. 2021-10-06
    Dose 3 — Moderna
    Co-administered: Flu
  25. 2021-10-25
    Health check-in — day 14, dose 3
    Feeling: Good
    Adult check-in
  26. 2021-10-27
    Health check-in — day 21, dose 3
    Feeling: Good
    Adult check-in
  27. 2021-11-03
    Health check-in — day 28, dose 3
    Feeling: Good
    Adult check-in
  28. 2021-11-11
    Health check-in — day 35, dose 3
    Feeling: Good
    Adult check-in
  29. 2022-01-08
    Health check-in — 3 months, dose 3
    Feeling: Good
    Adult check-in
  30. 2022-04-06
    Survey response — 6 months, dose 3
    MedDRA: Nasopharyngitis — Feeling: Good
    Free text: Cold like symptoms.
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-01-20Moderna
22021-02-18Moderna
32021-10-06Moderna Flu

Free text

Release 4 — day 7, dose 2

2021-02-25

Systemic reaction (other): I was repeatedly dizzy after my second vaccination. Approximately 1.5 hrs after that vaccination, I passed out and was woken by a woman who found me laying against my car steering wheel with the horn going off. (I had pulled over due to feeling dizzy). Dizziness and lightheadedness passed after about 5 hours. Fever, aches and fatigue followed and lasted about 24 hours. Then I felt fine. I did not receive this survey until several days after my second vaccination, and it only asks about thr previous 24 hour period. So I thought I would report it in this field..

Release 5 — day 21, dose 2

2021-03-11

Symptoms: Diarrhea

Release 9 — 6 months, dose 2

2021-08-19

Symptoms: Diarrhea lasting about 2 weeks -- believed to be associated with Celiac Disease

Release 11 — 6 months, dose 3

2022-04-06

Symptoms: Cold like symptoms.

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
SDDiarrhoea ✓ ✓ ✓
SDNasopharyngitis · · ✓
SDPre-existing disease ✓ · ✓
SRODizziness ✓ ✓ ✓
SROFatigue ✓ ✓ ✓
SROImpaired driving ability ✓ ✓ ✓
SROLoss of consciousness ✓ ✓ ✓
SROPain ✓ ✓ ✓
SROPyrexia ✓ ✓ ✓

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