587-11009-39358
4 vaccinations
9 coded responses
50 check-ins
9 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 36-40
- ZIP prefix
- 150 / PA
- Registered
- 2021-03-12
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
4MB-25112-21398
Child or adolescent in my care · Male · 2021-11-20
Timeline
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2021-03-12
Registered in v-safe
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2021-03-12
Dose 1 — Moderna
- 2021-03-12
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2021-03-13
Survey response — days 1–6 daily, dose 1MedDRA: Feeling hot — Feeling: Good · Site: PainFree text: I had a warm sensation in the back of my throat and the on my tounge about 10 minutes after my shot. It lasted for about a minute to 90 seconds.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-05
- 2021-04-09
-
2021-04-10
Dose 2 — Moderna
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2021-04-10
Survey response — day 0, dose 2MedDRA: Immediate post-injection reaction, Medical observation, Sensation of foreign body, Swollen tongue — Feeling: Good · Site: Pain · Get care from a doctor or other healthcare professionalFree text: Systemic reaction (other): The back of my tounge started to swell and felt a lumo in my throat about 90 seconds after recieving the shot.. · Healthcare visit (other): Care from doctor at injection clinic.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-10
Report sent to call center — day 0, dose 2Get care from a doctor or other healthcare professional1 call case(s)
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2021-04-11
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Chills, Muscle or body aches · Be unable to do your normal daily activitiesAdult check-in
- 2021-04-12
-
2021-04-13
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2021-04-14
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-04-15
- 2021-04-16
- 2021-04-17
- 2021-04-24
- 2021-05-02
- 2021-05-08
- 2021-05-15
- 2021-05-22
- 2021-07-10
- 2021-10-10
-
2021-11-05
Dose 3 — Janssen/Johnson & Johnson
- 2021-11-05
-
2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-11-07
-
2021-11-08
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-11-09
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2021-11-12
Survey response — day 7, dose 3MedDRA: Pain in extremity — Feeling: Good · Muscle or body achesFree text: Pain in right calfMedDRA releases: 2024-11 · check-in free text available
- 2021-11-19
- 2021-11-26
- 2021-12-05
- 2021-12-10
- 2021-12-17
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2022-02-04
Survey response — 3 months, dose 3MedDRA: Chills, Cough, Dysgeusia, Oropharyngeal pain, Pain, Pyrexia — Feeling: Good · 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 visit, Emergency room or emergency department visitFree text: Sore throat, fever up to 103 degrees, chills, body aches, coughing, bitter taste left in my mouth for over 2 weeks.MedDRA releases: 2024-11 · check-in free text available
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2022-02-04
Report sent to call center — 3 months, dose 3Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare prTelehealth, virtual health, or email health consultation · Outpatient clinic or urgent care clinic visit · Emergency room or emergency department visit · 1 call case(s)
- 2022-02-07
-
2022-02-07
Call successfulNot applicable (accidental reporting or does not believe symptoms are related to vaccine)
- 2022-05-06
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2022-09-28
Dose 4 — Pfizer-BioNTech
-
2022-09-30
Survey response — days 1–6 daily, dose 4MedDRA: Axillary pain — Feeling: Fair · Site: SwellingFree text: Paun in armpit of the arm that was injectedMedDRA releases: 2024-11 · check-in free text available
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2022-10-01
Survey response — days 1–6 daily, dose 4MedDRA: Axillary pain, Injection site pain — Feeling: Good · Site: PainFree text: Pain in arm pit and pectoral muscle on arm where i got the shot.MedDRA releases: 2024-11 · check-in free text available
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2022-10-02
Survey response — days 1–6 daily, dose 4MedDRA: Axillary pain, Myalgia — Feeling: GoodFree text: Mild pain under arm abd pectoral muscle in arm that got the shot.MedDRA releases: 2024-11 · check-in free text available
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2022-10-03
Survey response — days 1–6 daily, dose 4MedDRA: Axillary pain — Feeling: GoodFree text: Mild pain under left armMedDRA releases: 2024-11 · check-in free text available
- 2022-10-05
- 2022-10-12
- 2022-10-20
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2022-10-26
Survey response — day 28, dose 4MedDRA: Abdominal discomfort, Chills, Pain — Feeling: FairFree text: Chills, body aches, and sensitive stomachMedDRA releases: 2024-11 · check-in free text available
- 2022-11-02
- 2022-12-28
- 2023-03-29
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-12 | Moderna | |
| 2 | 2021-04-10 | Moderna | |
| 3 | 2021-11-05 | Janssen/Johnson & Johnson | No |
| 4 | 2022-09-28 | Pfizer-BioNTech | No |
Call center
2 call center cases
2 successful
Free text
Release 5 — days 1–6 daily, dose 1
Systemic reaction (other): I had a warm sensation in the back of my throat and the on my tounge about 10 minutes after my shot. It lasted for about a minute to 90 seconds.
Release 7 — day 0, dose 2
Systemic reaction (other): The back of my tounge started to swell and felt a lumo in my throat about 90 seconds after recieving the shot..
Healthcare visit (other): Care from doctor at injection clinic.
Release 10 — day 7, dose 3
Systemic reaction (other): Pain in right calf
Release 11 — 3 months, dose 3
Symptoms: Sore throat, fever up to 103 degrees, chills, body aches, coughing, bitter taste left in my mouth for over 2 weeks.
Release 12 — days 1–6 daily, dose 4
Systemic reaction (other): Paun in armpit of the arm that was injected
Systemic reaction (other): Pain in arm pit and pectoral muscle on arm where i got the shot.
Systemic reaction (other): Mild pain under arm abd pectoral muscle in arm that got the shot.
Systemic reaction (other): Mild pain under left arm
Release 12 — day 28, dose 4
Symptoms: Chills, body aches, and sensitive stomach
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 | Medical observation | ✓ | ✓ | ✓ |
| SD | Abdominal discomfort | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Dysgeusia | · | · | ✓ |
| SD | Oropharyngeal pain | · | · | ✓ |
| SD | Pain | · | · | ✓ |
| SD | Pyrexia | · | · | ✓ |
| SRO | Axillary pain | · | · | ✓ |
| SRO | Feeling hot | ✓ | ✓ | ✓ |
| SRO | Immediate post-injection reaction | ✓ | ✓ | ✓ |
| SRO | Injection site pain | · | · | ✓ |
| SRO | Myalgia | · | · | ✓ |
| SRO | Pain in extremity | · | · | ✓ |
| SRO | Sensation of foreign body | ✓ | ✓ | ✓ |
| SRO | Swollen tongue | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release