54M-12276-95111
4 vaccinations
6 coded responses
49 check-ins
6 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 922 / CA
- Registered
- 2021-01-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-01-30
Registered in v-safe
-
2021-01-30
Dose 1 — Moderna
- 2021-01-30
-
2021-01-31
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
- 2021-02-05
- 2021-02-06
- 2021-02-13
- 2021-02-20
-
2021-02-27
Dose 2 — Moderna
- 2021-02-27
-
2021-02-28
Survey response — days 1–6 daily, dose 2MedDRA: Decreased appetite — Feeling: Fair · Site: Pain · Headache, Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Loss of appetiteMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-01
- 2021-03-02
- 2021-03-03
- 2021-03-04
- 2021-03-05
- 2021-03-06
-
2021-03-13
Survey response — day 14, dose 2MedDRA: Dacryocanaliculitis, Facial pain — Feeling: GoodFree text: I believe that I have developed an infected tear duct under my left eye and it seems to be causing pain on the left side of my face. I have no reason to think this is related to my vaccine but I thought I would just report it anyway.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-20
- 2021-03-27
- 2021-04-03
- 2021-04-10
- 2021-05-29
- 2021-08-28
-
2021-10-25
Dose 3 — Moderna
- 2021-10-25
-
2021-10-26
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fatigue or tiredness, Abdominal pain · Be unable to do your normal daily activitiesAdult check-in
- 2021-10-27
-
2021-10-28
Survey response — days 1–6 daily, dose 3MedDRA: Injection site erythema, Injection site rash — Feeling: Good · Site: Redness, ItchingFree text: This is my first injection that has caused a significant rash and redness at the injection siteMedDRA releases: 2024-11 · check-in free text available
- 2021-10-29
- 2021-10-30
- 2021-10-31
- 2021-11-01
- 2021-11-08
- 2021-11-15
-
2021-11-22
Survey response — day 28, dose 3MedDRA: Diarrhoea — Feeling: FairFree text: Mild diarrheaMedDRA releases: 2024-11 · check-in free text available
-
2021-11-29
Survey response — day 35, dose 3MedDRA: Unevaluable event — Feeling: FairFree text: Bladder infection maybeMedDRA releases: 2024-11 · check-in free text available
- 2021-12-06
- 2022-01-24
-
2022-04-08
Dose 4 — Moderna
- 2022-04-14
- 2022-04-15
- 2022-04-22
-
2022-04-29
Survey response — day 21, dose 4MedDRA: Asthenia, Nasopharyngitis, SARS-CoV-2 test negative, Somnolence — Feeling: Fair · Be unable to do your normal daily activitiesFree text: head cold symptoms and lack of energy. Sleepy. Took a Covid test and it shows negative. This may be my pollen allergies acting up againMedDRA releases: 2024-11 · check-in free text available
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-07-08
- 2022-10-07
- 2023-04-08
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-30 | Moderna | |
| 2 | 2021-02-27 | Moderna | |
| 3 | 2021-10-25 | Moderna | No |
| 4 | 2022-04-08 | Moderna | No |
Free text
Release 4 — days 1–6 daily, dose 2
Systemic reaction (other): Loss of appetite
Release 5 — day 14, dose 2
Symptoms: I believe that I have developed an infected tear duct under my left eye and it seems to be causing pain on the left side of my face. I have no reason to think this is related to my vaccine but I thought I would just report it anyway.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): This is my first injection that has caused a significant rash and redness at the injection site
Release 10 — day 28, dose 3
Symptoms: Mild diarrhea
Release 10 — day 35, dose 3
Symptoms: Bladder infection maybe
Release 11 — day 21, dose 4
Symptoms: head cold symptoms and lack of energy. Sleepy. Took a Covid test and it shows negative. This may be my pollen allergies acting up again
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 | Asthenia | · | · | ✓ |
| SD | Dacryocanaliculitis | ✓ | ✓ | ✓ |
| SD | Diarrhoea | · | · | ✓ |
| SD | Facial pain | ✓ | ✓ | ✓ |
| SD | Nasopharyngitis | · | · | ✓ |
| SD | SARS-CoV-2 test negative | · | · | ✓ |
| SD | Somnolence | · | · | ✓ |
| SD | Unevaluable event | · | · | ✓ |
| SRO | Decreased appetite | ✓ | ✓ | ✓ |
| SRO | Injection site erythema | · | · | ✓ |
| SRO | Injection site rash | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release