4TM-27865-15280
5 vaccinations
9 coded responses
64 check-ins
9 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 660 / KS
- Registered
- 2021-03-20
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-18
Dose 1 — Moderna
-
2021-03-19
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
-
2021-03-20
Registered in v-safe
- 2021-03-20
- 2021-03-21
- 2021-03-22
- 2021-03-23
- 2021-03-24
- 2021-03-26
- 2021-04-01
- 2021-04-08
-
2021-04-15
Dose 2 — Moderna
- 2021-04-15
-
2021-04-16
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · None · Be unable to do your normal daily activitiesAdult check-in
- 2021-04-17
- 2021-04-18
- 2021-04-19
- 2021-04-20
- 2021-04-21
- 2021-04-22
- 2021-04-29
- 2021-05-06
- 2021-05-13
- 2021-05-20
- 2021-05-27
- 2021-07-15
- 2021-10-14
-
2021-10-27
Dose 3 — Pfizer-BioNTech
- 2021-10-28
-
2021-10-29
Survey response — days 1–6 daily, dose 3MedDRA: Dizziness — Feeling: Fair · Nausea · Be unable to do your normal daily activitiesFree text: DizzynessMedDRA releases: 2024-11 · check-in free text available
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
-
2021-11-11
Survey response — day 14, dose 3MedDRA: Cough, Nasopharyngitis, Respiratory tract congestion, Sneezing — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Have a cold. Congestion, sneezing, cough, stuffiness. Typical cold. Think I caught it from my grandson.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-17
- 2021-11-24
- 2021-12-01
- 2021-12-08
- 2022-01-26
-
2022-04-26
Dose 4 — Pfizer-BioNTech
- 2022-04-26
- 2022-04-27
- 2022-04-28
- 2022-04-29
- 2022-04-30
- 2022-05-01
- 2022-05-02
- 2022-05-03
- 2022-05-10
-
2022-05-17
Survey response — day 21, dose 4MedDRA: Respiratory tract congestion — Feeling: GoodFree text: Slight chest congestion for just one day. Went away quickMedDRA releases: 2024-11 · check-in free text available
- 2022-05-24
-
2022-05-31
Survey response — day 35, dose 4MedDRA: Nasopharyngitis — Feeling: GoodFree text: Slight head coldMedDRA releases: 2024-11 · check-in free text available
-
2022-06-07
Survey response — day 42, dose 4MedDRA: Nasopharyngitis — Feeling: Fair · Be unable to do your normal daily activitiesFree text: ColdMedDRA releases: 2024-11 · check-in free text available
-
2022-07-26
Survey response — 3 months, dose 4MedDRA: Chest pain, Musculoskeletal pain, Office visit, Pain in extremity, Pain of skin, Pruritus — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Pain and itching on left shoulder blade that extends under left arm and halfway across left chest. Appears to be skin pain and not muscle or bone pain. Similar to sunburn, but is not a sunburn and shows no rash or other skin irritation. · Healthcare visit (other): Primary care doctor visit in personMedDRA releases: 2024-11 · check-in free text available
-
2022-07-26
Report sent to call center — 3 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-07-27
-
2022-09-22
Dose 5 — Pfizer-BioNTechCo-administered: Flu
- 2022-09-23
- 2022-09-24
- 2022-09-26
- 2022-09-27
- 2022-09-28
- 2022-09-29
-
2022-10-08
Survey response — day 14, dose 5MedDRA: Nausea, Vomiting — Feeling: Good · Be unable to do your normal daily activitiesFree text: Nausea and vomiting. But I do not believe this was associated with the vaccine. I believe it was good poisoning, but no way to know for sure.MedDRA releases: 2024-11 · check-in free text available
- 2022-10-13
- 2022-10-20
- 2022-10-27
-
2022-11-03
Survey response — day 42, dose 5MedDRA: Arthralgia, Asthenia, COVID-19, Cough, Influenza like illness, Lethargy, Office visit, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Sneezing — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: Covid. Incredible congestion, coughing, sneezing, joint pain, low-grade fever, weakness, lethargy. Like a really bad flu without the diarrhea and vomiting. Used at-home test to determine. Went to urgent care doctor.MedDRA releases: 2024-11 · check-in free text available
-
2022-11-03
Report sent to call center — day 42, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalOutpatient clinic or urgent care clinic visit · 1 call case(s)
-
2022-11-04
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-11-04
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
-
2022-12-22
Survey response — 3 months, dose 5MedDRA: Coronary arterial stent insertion — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · HospitalizationFree text: Symptoms: Had two stents put into my heart. Not related to vaccines at all. · Healthcare visit (other): Heart catheterization and two stentsMedDRA releases: 2024-11 · check-in free text available
-
2022-12-22
Report sent to call center — 3 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalHospitalization · 1 call case(s)
- 2022-12-23
- 2023-03-23
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-18 | Moderna | |
| 2 | 2021-04-15 | Moderna | |
| 3 | 2021-10-27 | Pfizer-BioNTech | No |
| 4 | 2022-04-26 | Pfizer-BioNTech | No |
| 5 | 2022-09-22 | Pfizer-BioNTech | Flu |
Call center
3 call center cases
2 successful · 1 unsuccessful
Free text
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Dizzyness
Release 10 — day 14, dose 3
Symptoms: Have a cold. Congestion, sneezing, cough, stuffiness. Typical cold. Think I caught it from my grandson.
Release 11 — day 21, dose 4
Symptoms: Slight chest congestion for just one day. Went away quick
Release 11 — day 35, dose 4
Symptoms: Slight head cold
Release 11 — day 42, dose 4
Symptoms: Cold
Release 12 — 3 months, dose 4
Symptoms: Pain and itching on left shoulder blade that extends under left arm and halfway across left chest. Appears to be skin pain and not muscle or bone pain. Similar to sunburn, but is not a sunburn and shows no rash or other skin irritation.
Healthcare visit (other): Primary care doctor visit in person
Release 12 — day 14, dose 5
Symptoms: Nausea and vomiting. But I do not believe this was associated with the vaccine. I believe it was good poisoning, but no way to know for sure.
Release 12 — day 42, dose 5
Symptoms: Covid. Incredible congestion, coughing, sneezing, joint pain, low-grade fever, weakness, lethargy. Like a really bad flu without the diarrhea and vomiting. Used at-home test to determine. Went to urgent care doctor.
Release 12 — 3 months, dose 5
Symptoms: Had two stents put into my heart. Not related to vaccines at all.
Healthcare visit (other): Heart catheterization and two stents
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 |
|---|---|---|---|---|
| HCVO | Coronary arterial stent insertion | · | · | ✓ |
| HCVO | Office visit | · | · | ✓ |
| SD | Arthralgia | · | · | ✓ |
| SD | Asthenia | · | · | ✓ |
| SD | Chest pain | · | · | ✓ |
| SD | Coronary arterial stent insertion | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Influenza like illness | · | · | ✓ |
| SD | Lethargy | · | · | ✓ |
| SD | Musculoskeletal pain | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Nausea | · | · | ✓ |
| SD | Office visit | · | · | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SD | Pain of skin | · | · | ✓ |
| SD | Pruritus | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Sneezing | · | · | ✓ |
| SD | Vomiting | · | · | ✓ |
| SRO | Dizziness | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release