556-55378-47875
2 vaccinations
7 coded responses
14 check-ins
7 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 51-55
- ZIP prefix
- 070 / NJ
- Registered
- 2021-05-11
- Relationship
- Self
- Race
- N/A
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-04-13
Dose 1 — Moderna
-
2021-05-11
Registered in v-safe
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2021-05-11
Dose 2 — Moderna
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2021-05-11
Survey response — day 0, dose 2MedDRA: Brain fog, Myalgia — Feeling: Fair · Muscle or body achesFree text: 10am shot, 3pm muscle ache in biceps, 4pm fog cant think strait.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-12
Survey response — days 1–6 daily, dose 2MedDRA: Cough — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesFree text: Painful coughMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-13
Survey response — days 1–6 daily, dose 2MedDRA: Abdominal pain upper — Feeling: Fair · HeadacheFree text: Stomach ache maybe not related.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-14
Survey response — days 1–6 daily, dose 2MedDRA: Insomnia — Feeling: Fair · Muscle or body achesFree text: InsomniaMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-15
- 2021-05-16
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2021-05-19
Survey response — day 7, dose 2MedDRA: Unevaluable event — Feeling: Fair · Joint pains, Muscle or body aches, Nausea, Abdominal painFree text: Chest, left shoulder and lower back. Lower back for the last three days. Chest and shoulder just recently.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-05-26
- 2021-06-01
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2021-06-11
Survey response — day 28, dose 2MedDRA: Pneumonia, Unevaluable event — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · HospitalizationFree text: Symptoms: May not be related but I came down with apparent aspirated pneumonia after anesthesia during routine colonoscopy. · Healthcare visit (other): May not be related to vaccineMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-11
Report sent to call center — day 28, dose 2Be unable to work or attend school · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-17
- 2021-06-22
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2021-06-22
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2021-08-10
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2022-05-11
Survey response — 12 months, dose 2MedDRA: COVID-19 — Feeling: Fair · Be unable to work or attend schoolFree text: Caught Covid - probably omicron - symptoms were no worse than a bad cold.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-04-13 | Moderna | |
| 2 | 2021-05-11 | Moderna |
Call center
1 call center case
1 successful
Free text
Release 8 — day 0, dose 2
Systemic reaction (other): 10am shot, 3pm muscle ache in biceps, 4pm fog cant think strait.
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Painful cough
Systemic reaction (other): Stomach ache maybe not related.
Systemic reaction (other): Insomnia
Release 8 — day 7, dose 2
Systemic reaction (other): Chest, left shoulder and lower back. Lower back for the last three days. Chest and shoulder just recently.
Release 9 — day 28, dose 2
Symptoms: May not be related but I came down with apparent aspirated pneumonia after anesthesia during routine colonoscopy.
Healthcare visit (other): May not be related to vaccine
Release 11 — 12 months, dose 2
Symptoms: Caught Covid - probably omicron - symptoms were no worse than a bad cold.
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 | Unevaluable event | ✓ | ✓ | ✓ |
| SD | COVID-19 | · | · | ✓ |
| SD | Pneumonia | ✓ | ✓ | ✓ |
| SRO | Abdominal pain upper | ✓ | ✓ | ✓ |
| SRO | Brain fog | ✓ | ✓ | ✓ |
| SRO | Cough | ✓ | ✓ | ✓ |
| SRO | Insomnia | ✓ | ✓ | ✓ |
| SRO | Myalgia | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release