4U7-14942-94914
5 vaccinations
11 coded responses
46 check-ins
10 free-text entries
3 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 629 / IL
- Registered
- 2021-01-21
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-21
Registered in v-safe
-
2021-01-22
Dose 1 — Moderna
- 2021-01-22
-
2021-01-23
Survey response — days 1–6 daily, dose 1MedDRA: Injection site pain — Feeling: Good · Site: PainFree text: Just soreness around injection siteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-24
Survey response — days 1–6 daily, dose 1MedDRA: Arthralgia, Self-medication — Feeling: Good · Muscle or body achesFree text: Sharp pain in my right side just above hip about 1:30 am. Took a Tylenol and it helped enough so I could eventually return to sleep. A little pain this am but I feel no psin now at 2:30 pm.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-25
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2021-01-26
Survey response — days 1–6 daily, dose 1MedDRA: Myalgia, Self-medication — Feeling: Good · Muscle or body achesFree text: The muscle pain was again in the middle of the night and was a sharp pain in myower right side. It was not as intense as two nights ago and Tylenol allow me to eventually return to sleep. No problem today.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-27
-
2021-01-29
Survey response — day 7, dose 1MedDRA: Emergency care, Unevaluable event — Feeling: Fair · Muscle or body aches, Nausea, Abdominal pain · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visitFree text: Systemic reaction (other): Sharp in .y lower right side in front and back · Healthcare visit (other): At ER now. I think it is a kidney stone but have not see a doctor yet.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-01-29
Report sent to call center — day 7, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
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2021-02-05
Survey response — day 14, dose 1MedDRA: Nephrolithiasis — 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: Kidney Stone. Too big to pass I will need surgeryMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-05
Report sent to call center — day 14, dose 1Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-02-12
- 2021-02-19
-
2021-02-22
Dose 2 — Moderna
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2021-02-24
Survey response — days 1–6 daily, dose 2MedDRA: Asthenia, Cardiac stress test, Electrocardiogram normal, Loss of personal independence in daily activities — Feeling: Fair · Chills, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to do your normal daily activitiesFree text: Since I received first shot I feel like I don't have the strengthvto climb stsirs or even walk out to the mailbox at times. I have had an EKG and Stress test and my heart came out strong. btMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-25
Survey response — days 1–6 daily, dose 2MedDRA: Asthenia — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Feel week when I exert myself. Not sure if it related to the vaccines. I started feeling this way after first shot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-26
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue — Feeling: Good · NauseaFree text: Exhaustion upon exertionMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-27
- 2021-02-28
- 2021-03-01
- 2021-03-08
- 2021-03-15
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2021-03-24
Survey response — day 28, dose 2MedDRA: Asthenia, Fatigue, Pre-existing disease — Feeling: FairFree text: I was diagnosed with mild leukopenia and Thrombocytopenia. I have felt tired and weak at times since my 1st shot 0f Moderna on Jan 22. My platelet count is 128 now. It was 139 on Feb 4th. However my platelet count was 123 in Jan 2017.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-29
- 2021-04-05
- 2021-05-24
-
2021-06-09
Call successfulNot applicable - Accidental Reporting
-
2021-06-09
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-08-23
-
2021-10-29
Dose 3 — Moderna
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-20
- 2021-11-26
- 2021-12-03
- 2021-12-10
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2022-01-28
Survey response — 3 months, dose 3MedDRA: Feeling abnormal, SARS-CoV-2 test positive — Feeling: GoodFree text: Tested positive for Corvid using PCR test on Jan 1. I was feeling poorly for one day and by 3rd day I felt good again. No fever no loss of taste or smell.MedDRA releases: 2024-11 · check-in free text available
- 2022-04-29
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2022-07-11
Dose 4 — Moderna
-
2022-09-13
Dose 5 — Moderna
- 2022-09-22
- 2022-09-27
- 2022-10-06
- 2022-10-11
- 2022-10-18
- 2022-10-25
- 2022-12-13
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2023-03-14
Survey response — 6 months, dose 5MedDRA: Abdominal pain upper, Dyspnoea, Headache, Influenza, Influenza A virus test negative, Influenza B virus test negative, Myalgia, Nasopharyngitis, Respiratory tract congestion, SARS-CoV-2 test negative — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitMedDRA releases: 2024-11
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2023-03-14
Report sent to call center — 6 months, dose 5Be unable to do your normal daily activities · Get care from a doctor or other healthcare professionalTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · 1 call case(s)
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2023-03-15
Call successfulNot applicable - Accidental Reporting
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-22 | Moderna | |
| 2 | 2021-02-22 | Moderna | |
| 3 | 2021-10-29 | Moderna | No |
| 4 | 2022-07-11 | Moderna | No |
| 5 | 2022-09-13 | Moderna | No |
Call center
3 call center cases
3 successful
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Just soreness around injection site
Systemic reaction (other): Sharp pain in my right side just above hip about 1:30 am. Took a Tylenol and it helped enough so I could eventually return to sleep. A little pain this am but I feel no psin now at 2:30 pm.
Systemic reaction (other): The muscle pain was again in the middle of the night and was a sharp pain in myower right side. It was not as intense as two nights ago and Tylenol allow me to eventually return to sleep. No problem today.
Release 3 — day 7, dose 1
Systemic reaction (other): Sharp in .y lower right side in front and back
Healthcare visit (other): At ER now. I think it is a kidney stone but have not see a doctor yet.
Release 3 — day 14, dose 1
Symptoms: Kidney Stone. Too big to pass I will need surgery
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Since I received first shot I feel like I don't have the strengthvto climb stsirs or even walk out to the mailbox at times. I have had an EKG and Stress test and my heart came out strong. bt
Systemic reaction (other): Feel week when I exert myself. Not sure if it related to the vaccines. I started feeling this way after first shot.
Systemic reaction (other): Exhaustion upon exertion
Release 6 — day 28, dose 2
Symptoms: I was diagnosed with mild leukopenia and Thrombocytopenia. I have felt tired and weak at times since my 1st shot 0f Moderna on Jan 22. My platelet count is 128 now. It was 139 on Feb 4th. However my platelet count was 123 in Jan 2017.
Release 11 — 3 months, dose 3
Symptoms: Tested positive for Corvid using PCR test on Jan 1. I was feeling poorly for one day and by 3rd day I felt good again. No fever no loss of taste or smell.
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 | Emergency care | ✓ | ✓ | ✓ |
| SD | Abdominal pain upper | · | · | ✓ |
| SD | Asthenia | ✓ | ✓ | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Feeling abnormal | · | · | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Influenza | · | · | ✓ |
| SD | Influenza A virus test negative | · | · | ✓ |
| SD | Influenza B virus test negative | · | · | ✓ |
| SD | Myalgia | · | · | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | Nephrolithiasis | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SRO | Arthralgia | ✓ | ✓ | ✓ |
| SRO | Asthenia | ✓ | ✓ | ✓ |
| SRO | Cardiac stress test | ○ | ✓ | ○ |
| SRO | Electrocardiogram normal | ○ | ✓ | ○ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Injection site pain | ✓ | ✓ | ✓ |
| SRO | Loss of personal independence in daily activities | ✓ | ✓ | ✓ |
| SRO | Myalgia | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release