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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

  1. 2021-04-13
    Dose 1 — Moderna
  2. 2021-05-11
    Registered in v-safe
  3. 2021-05-11
    Dose 2 — Moderna
  4. 2021-05-11
    Survey response — day 0, dose 2
    MedDRA: Brain fog, Myalgia — Feeling: Fair · Muscle or body aches
    Free 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
  5. 2021-05-12
    Survey response — days 1–6 daily, dose 2
    MedDRA: Cough — Feeling: Poor · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activities
    Free text: Painful cough
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  6. 2021-05-13
    Survey response — days 1–6 daily, dose 2
    MedDRA: Abdominal pain upper — Feeling: Fair · Headache
    Free text: Stomach ache maybe not related.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-05-14
    Survey response — days 1–6 daily, dose 2
    MedDRA: Insomnia — Feeling: Fair · Muscle or body aches
    Free text: Insomnia
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-05-15
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Headache
    Adult check-in
  9. 2021-05-16
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · None
    Adult check-in
  10. 2021-05-19
    Survey response — day 7, dose 2
    MedDRA: Unevaluable event — Feeling: Fair · Joint pains, Muscle or body aches, Nausea, Abdominal pain
    Free 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
  11. 2021-05-26
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  12. 2021-06-01
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  13. 2021-06-11
    Survey response — day 28, dose 2
    MedDRA: Pneumonia, Unevaluable event — Feeling: Fair · Be unable to work or attend school, Get care from a doctor or other healthcare professional · Hospitalization
    Free 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 vaccine
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-06-11
    Report sent to call center — day 28, dose 2
    Be unable to work or attend school · Get care from a doctor or other healthcare professional
    1 call case(s)
  15. 2021-06-17
    Health check-in — day 35, dose 2
    Feeling: Fair
    Adult check-in
  16. 2021-06-22
    Health check-in — day 42, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-06-22
    Call successful
    Not applicable (accidental reporting or does not believe symptoms are related to vaccine)
  18. 2021-08-10
    Health check-in — 3 months, dose 2
    Feeling: Fair
    Adult check-in
  19. 2022-05-11
    Survey response — 12 months, dose 2
    MedDRA: COVID-19 — Feeling: Fair · Be unable to work or attend school
    Free text: Caught Covid - probably omicron - symptoms were no worse than a bad cold.
    MedDRA releases: 2024-11 · check-in free text available

Vaccinations

DoseDateManufacturerCo-administered
12021-04-13Moderna
22021-05-11Moderna

Call center

1 call center case

1 successful

See the call center timeline

Free text

Release 8 — day 0, dose 2

2021-05-11

Systemic reaction (other): 10am shot, 3pm muscle ache in biceps, 4pm fog cant think strait.

Release 8 — days 1–6 daily, dose 2

2021-05-12

Systemic reaction (other): Painful cough

2021-05-13

Systemic reaction (other): Stomach ache maybe not related.

2021-05-14

Systemic reaction (other): Insomnia

Release 8 — day 7, dose 2

2021-05-19

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

2021-06-11

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

2022-05-11

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

FieldPreferred term2021-092023-042024-11
HCVOUnevaluable event ✓ ✓ ✓
SDCOVID-19 · · ✓
SDPneumonia ✓ ✓ ✓
SROAbdominal pain upper ✓ ✓ ✓
SROBrain fog ✓ ✓ ✓
SROCough ✓ ✓ ✓
SROInsomnia ✓ ✓ ✓
SROMyalgia ✓ ✓ ✓
SROUnevaluable event ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release