4SX-17143-34893
5 vaccinations
13 coded responses
50 check-ins
13 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 352 / AL
- Registered
- 2021-01-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-13
Registered in v-safe
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2021-01-13
Dose 1 — Moderna
- 2021-01-13
- 2021-01-14
- 2021-01-15
- 2021-01-16
- 2021-01-17
- 2021-01-18
- 2021-01-19
- 2021-01-22
- 2021-01-27
- 2021-02-03
-
2021-02-09
Dose 2 — Moderna
-
2021-02-10
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-02-11
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to workAdult check-in
- 2021-02-12
- 2021-02-13
- 2021-02-15
- 2021-02-16
- 2021-02-23
- 2021-03-02
- 2021-03-09
- 2021-03-16
- 2021-03-23
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2021-05-11
Survey response — 3 months, dose 2MedDRA: Arthropod bite, Chills, Erythema, Infected bite, Myalgia, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Presumed Tick bite infection 10d ago. Myalgia, NO fever.shivers. 2 nickel size erythema RUArm+bite. Covid PCR Neg. No serology collected. Doxycycline 100 Bid x 10days with relief of symptoms within 48 hrs.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-11
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-08-10
-
2021-09-11
Dose 3 — Moderna
- 2021-10-25
- 2021-12-11
-
2022-01-19
Call successfulDoes not wish to fill out VAERS report
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2022-03-12
Survey response — 6 months, dose 3MedDRA: Adverse reaction, Cardiac operation — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationFree text: Underwent cardiac surgery on 2/14/22 Symptoms totally UNRELATED to CovidMedDRA releases: 2024-11 · check-in free text available
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2022-03-12
Report sent to call center — 6 months, dose 3Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
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2022-03-17
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
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2022-05-14
Dose 4 — Moderna
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2022-05-14
Survey response — day 0, dose 4MedDRA: No adverse event — Feeling: Good · Site: PainFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2022-05-15
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Good · Site: PainFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2022-05-17
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: Good · Site: RednessFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2022-05-18
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2022-05-19
Survey response — days 1–6 daily, dose 4MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2022-05-21
Survey response — day 7, dose 4MedDRA: No adverse event — Feeling: GoodFree text: NOMedDRA releases: 2024-11 · check-in free text available
- 2022-05-28
- 2022-06-04
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2022-06-11
Survey response — day 28, dose 4MedDRA: Chest pain, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activitiesFree text: Pain in Left chest for 5 days; cause unclear. If not better on Monday, I plan to contact my primary MD. The time line is 4 months post Repair of the Mitral valve on Feb 14 2022MedDRA releases: 2024-11 · check-in free text available
- 2022-06-18
- 2022-06-25
- 2022-08-13
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2022-10-01
Dose 5 — ModernaCo-administered: Flu
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2022-10-03
Survey response — days 1–6 daily, dose 5MedDRA: No adverse event — Feeling: Good · Site: PainFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-10-05
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2022-10-06
Survey response — days 1–6 daily, dose 5MedDRA: No adverse event — Feeling: GoodFree text: NOMedDRA releases: 2024-11 · check-in free text available
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2022-10-07
Survey response — days 1–6 daily, dose 5MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
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2022-10-08
Survey response — day 7, dose 5MedDRA: No adverse event — Feeling: GoodFree text: NoMedDRA releases: 2024-11 · check-in free text available
- 2022-10-15
- 2022-10-22
- 2022-10-29
- 2022-11-05
- 2022-11-12
- 2022-12-31
- 2023-04-01
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-13 | Moderna | |
| 2 | 2021-02-09 | Moderna | |
| 3 | 2021-09-11 | Moderna | No |
| 4 | 2022-05-14 | Moderna | No |
| 5 | 2022-10-01 | Moderna | Flu |
Call center
2 call center cases
2 successful
Free text
Release 8 — 3 months, dose 2
Symptoms: Presumed Tick bite infection 10d ago. Myalgia, NO fever.shivers. 2 nickel size erythema RUArm+bite. Covid PCR Neg. No serology collected. Doxycycline 100 Bid x 10days with relief of symptoms within 48 hrs.
Release 11 — 6 months, dose 3
Symptoms: Underwent cardiac surgery on 2/14/22 Symptoms totally UNRELATED to Covid
Release 11 — day 0, dose 4
Systemic reaction (other): No
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): No
Systemic reaction (other): No
Systemic reaction (other): No
Systemic reaction (other): No
Release 11 — day 7, dose 4
Systemic reaction (other): NO
Release 12 — day 28, dose 4
Symptoms: Pain in Left chest for 5 days; cause unclear. If not better on Monday, I plan to contact my primary MD. The time line is 4 months post Repair of the Mitral valve on Feb 14 2022
Release 12 — days 1–6 daily, dose 5
Systemic reaction (other): No
Systemic reaction (other): NO
Systemic reaction (other): No
Release 12 — day 7, dose 5
Systemic reaction (other): No
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 | Adverse reaction | · | · | ✓ |
| SD | Arthropod bite | ✓ | ✓ | ✓ |
| SD | Cardiac operation | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | Erythema | ✓ | ✓ | ✓ |
| SD | Infected bite | ✓ | ✓ | ✓ |
| SD | Myalgia | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | SARS-CoV-2 test negative | ✓ | ✓ | ✓ |
| SRO | No adverse event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release