4Z6-65798-07412
2 vaccinations
4 coded responses
24 check-ins
4 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 41-45
- ZIP prefix
- 554 / MN
- Registered
- 2021-01-29
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-29
Registered in v-safe
-
2021-01-29
Dose 1 — Moderna
- 2021-01-29
-
2021-01-30
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Headache, Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
-
2021-01-31
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
-
2021-02-01
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesAdult check-in
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-12
- 2021-02-19
-
2021-02-27
Survey response — day 28, dose 1MedDRA: Heart rate increased — Feeling: FairFree text: Increased heart rate (100-130 BPM) compared to my usual heart rate of 77-90 while seated or standingMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-03-01
Dose 2 — Moderna
- 2021-03-04
- 2021-03-05
- 2021-03-06
- 2021-03-07
- 2021-03-08
- 2021-03-15
-
2021-03-22
Survey response — day 21, dose 2MedDRA: Fatigue — Feeling: GoodFree text: FatigueMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-29
- 2021-04-05
- 2021-04-12
- 2021-05-31
-
2021-08-30
Survey response — 6 months, dose 2MedDRA: Dyspnoea — Feeling: Fair · Be unable to work or attend school, 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 visitFree text: Shortness of breath, beginning in July. I initially thought it was related to poor air quality due to forest fires, but the air quality improved, and my breathing is worsening.MedDRA releases: 2021-09,2024-11 · check-in free text available
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2021-08-30
Report sent to call center — 6 months, dose 2Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr1 call case(s)
- 2021-09-03
-
2021-09-03
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
-
2022-03-03
Survey response — 12 months, dose 2MedDRA: Cardiomyopathy, Pre-existing disease — Feeling: Good · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation, Outpatient clinic or urgent care clinic visitFree text: I was diagnosed with non-ischemic cardiomyopathy, likely a consequence of COVID-19, but in no way related to the vaccine (I got sick before the vaccine was available)MedDRA releases: 2024-11 · check-in free text available
-
2022-03-03
Report sent to call center — 12 months, dose 2Get 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)
- 2022-03-04
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-29 | Moderna | |
| 2 | 2021-03-01 | Moderna |
Call center
2 call center cases
1 successful · 1 unsuccessful
Free text
Release 4 — day 28, dose 1
Symptoms: Increased heart rate (100-130 BPM) compared to my usual heart rate of 77-90 while seated or standing
Release 6 — day 21, dose 2
Symptoms: Fatigue
Release 9 — 6 months, dose 2
Symptoms: Shortness of breath, beginning in July. I initially thought it was related to poor air quality due to forest fires, but the air quality improved, and my breathing is worsening.
Release 11 — 12 months, dose 2
Symptoms: I was diagnosed with non-ischemic cardiomyopathy, likely a consequence of COVID-19, but in no way related to the vaccine (I got sick before the vaccine was available)
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 | Cardiomyopathy | · | · | ✓ |
| SD | Dyspnoea | ✓ | · | ✓ |
| SD | Fatigue | ✓ | ✓ | ✓ |
| SD | Heart rate increased | ✓ | ✓ | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release