4UG-22626-38812
3 vaccinations
10 coded responses
34 check-ins
10 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 925 / CA
- Registered
- 2021-02-04
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-04
Registered in v-safe
-
2021-02-04
Dose 1 — Moderna
- 2021-02-04
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2021-02-05
Survey response — days 1–6 daily, dose 1MedDRA: Headache, Pre-existing disease — Feeling: Good · Site: Pain · HeadacheFree text: I have davf frequent HA are commonMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-02-06
Survey response — days 1–6 daily, dose 1MedDRA: Headache, Pre-existing disease — Feeling: Good · HeadacheFree text: Typical HA with my hypertension and DAVFMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-07
- 2021-02-08
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2021-02-09
Survey response — days 1–6 daily, dose 1MedDRA: Headache, Pre-existing disease — Feeling: Fair · HeadacheFree text: HA most likely from (b)(6)MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-10
- 2021-02-11
- 2021-02-18
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2021-02-25
Survey response — day 21, dose 1MedDRA: Pyrexia, Self-medication — Feeling: GoodFree text: Feverish a few days ago I didnt check it. I took Tylenol and havent felt that way since.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-04
Dose 2 — Moderna
- 2021-03-04
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2021-03-05
Survey response — days 1–6 daily, dose 2MedDRA: Pre-existing disease — Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: (b)(6), DAVF, Hypertension, hx Bilateral PE.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-06
Survey response — days 1–6 daily, dose 2MedDRA: Hyperhidrosis — Feeling: Fair · Headache, Fatigue or tirednessFree text: Diaphoresis several times Thur and fri not right nowMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-07
Survey response — days 1–6 daily, dose 2MedDRA: Somnolence — Feeling: Fair · Fatigue or tirednessFree text: Slept really late no symptoms nowMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-08
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Headache, Fatigue or tirednessAdult check-in
- 2021-03-09
- 2021-03-10
- 2021-03-11
- 2021-03-18
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2021-03-25
Survey response — day 21, dose 2MedDRA: Fatigue — Feeling: FairFree text: FatigueMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-05
- 2021-04-08
- 2021-04-15
- 2021-06-05
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2021-10-25
Dose 3 — ModernaCo-administered: Flu
- 2021-10-25
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2021-10-27
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness, NauseaAdult check-in
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2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Emergency care, Headache, Hypertension — Feeling: Fair · Headache · Be unable to do your normal daily activitiesFree text: ED visit 10/26 HA and very difficult to control hypertension probably not related to Moderna booster.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-29
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2021-10-30
Survey response — days 1–6 daily, dose 3MedDRA: Headache, Pre-existing disease — Feeling: Fair · Headache · Be unable to do your normal daily activitiesFree text: HA most likely related to DAVF or frequent Migraines not vaccine.MedDRA releases: 2024-11 · check-in free text available
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2021-11-01
Health check-in — day 7, dose 3Feeling: Fair · Headache · Be unable to do your normal daily activitiesAdult check-in
- 2021-11-08
- 2021-12-06
- 2022-01-24
- 2022-10-25
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-04 | Moderna | |
| 2 | 2021-03-04 | Moderna | |
| 3 | 2021-10-25 | Moderna | Flu |
Free text
Release 3 — days 1–6 daily, dose 1
Systemic reaction (other): I have davf frequent HA are common
Systemic reaction (other): Typical HA with my hypertension and DAVF
Release 4 — day 21, dose 1
Symptoms: Feverish a few days ago I didnt check it. I took Tylenol and havent felt that way since.
Release 5 — days 1–6 daily, dose 2
Systemic reaction (other): Diaphoresis several times Thur and fri not right now
Systemic reaction (other): Slept really late no symptoms now
Release 6 — day 21, dose 2
Symptoms: Fatigue
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): ED visit 10/26 HA and very difficult to control hypertension probably not related to Moderna booster.
Systemic reaction (other): HA most likely related to DAVF or frequent Migraines not vaccine.
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 | Fatigue | ✓ | ✓ | ✓ |
| SD | Pyrexia | ✓ | ✓ | ✓ |
| SD | Self-medication | ✓ | ✓ | ✓ |
| SRO | Emergency care | · | · | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Hyperhidrosis | ✓ | ✓ | ✓ |
| SRO | Hypertension | · | · | ✓ |
| SRO | Pre-existing disease | ✓ | ✓ | ✓ |
| SRO | Somnolence | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release