5DM-30358-98749
3 vaccinations
7 coded responses
42 check-ins
7 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 36-40
- ZIP prefix
- 945 / CA
- Registered
- 2020-12-30
- Relationship
- Self
- Race
- Asian
- Ethnicity
- Not Hispanic or Latino
Registered dependents
5RC-24300-64307
Child or adolescent in my care · Female · 2022-01-16
Timeline
-
2020-12-30
Registered in v-safe
-
2020-12-30
Dose 1 — Moderna
- 2020-12-30
- 2020-12-31
- 2021-01-01
- 2021-01-02
-
2021-01-03
Survey response — days 1–6 daily, dose 1MedDRA: Self-medication — Feeling: GoodFree text: Forgot to reprot that I took Tylenol 500mg × 2 on 12/31/2020 before going to bedMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-04
- 2021-01-05
-
2021-01-06
Survey response — day 7, dose 1MedDRA: Axillary pain — Feeling: Good · Muscle or body achesFree text: The ache is at the armpit of the side receives the shot.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-13
- 2021-01-20
- 2021-01-27
-
2021-01-28
Dose 2 — Moderna
- 2021-01-28
-
2021-01-29
Survey response — days 1–6 daily, dose 2MedDRA: Chills, Pain, Self-medication, Sleep disorder — Feeling: Good · Site: Pain · Chills, Muscle or body achesFree text: Started to feel pain last night and woke up for a few times. More painful this morning, check temp was 98.x, started feels chill around 9am. Takes 2 tab. of Motrin after lunch and feels much better now.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-30
Survey response — days 1–6 daily, dose 2MedDRA: Headache, Self-medication — Feeling: Good · HeadacheFree text: The headache is partially resolved by tylenolMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-31
- 2021-02-01
- 2021-02-02
- 2021-02-03
- 2021-02-04
-
2021-02-11
Survey response — day 14, dose 2MedDRA: Mouth ulceration — Feeling: GoodFree text: Oral ulcerMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-02-18
- 2021-02-25
- 2021-03-04
- 2021-03-11
- 2021-04-29
-
2021-07-29
Survey response — 6 months, dose 2MedDRA: Headache, Respiratory tract congestion, Sneezing — Feeling: GoodFree text: About 2 months ago, my friend's son was sick, with sneezing and fever. My daughter got sick after playing with him. I also had symptoms including sneezing, congestion, and headache, but no fever.MedDRA releases: 2021-09,2024-11 · check-in free text available
-
2021-11-05
Dose 3 — Moderna
- 2021-11-05
-
2021-11-06
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-11-07
-
2021-11-08
Health check-in — days 1–6 daily, dose 3Feeling: Poor · Site: Pain · Headache, Muscle or body aches, Nausea · Be unable to work or attend schoolAdult check-in
- 2021-11-09
-
2021-11-10
Survey response — days 1–6 daily, dose 3MedDRA: Axillary pain, Lymphadenitis — Feeling: Good · Muscle or body achesFree text: Armpit pain on the injection side, probably caused by axillary lymphadenitisMedDRA releases: 2024-11 · check-in free text available
- 2021-11-11
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2021-12-17
- 2022-02-04
- 2022-05-06
- 2022-11-05
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2020-12-30 | Moderna | |
| 2 | 2021-01-28 | Moderna | |
| 3 | 2021-11-05 | Moderna | No |
Free text
Release 1 — days 1–6 daily, dose 1
Systemic reaction (other): Forgot to reprot that I took Tylenol 500mg × 2 on 12/31/2020 before going to bed
Release 1 — day 7, dose 1
Systemic reaction (other): The ache is at the armpit of the side receives the shot.
Release 3 — days 1–6 daily, dose 2
Systemic reaction (other): Started to feel pain last night and woke up for a few times. More painful this morning, check temp was 98.x, started feels chill around 9am. Takes 2 tab. of Motrin after lunch and feels much better now.
Systemic reaction (other): The headache is partially resolved by tylenol
Release 4 — day 14, dose 2
Symptoms: Oral ulcer
Release 9 — 6 months, dose 2
Symptoms: About 2 months ago, my friend's son was sick, with sneezing and fever. My daughter got sick after playing with him. I also had symptoms including sneezing, congestion, and headache, but no fever.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): Armpit pain on the injection side, probably caused by axillary lymphadenitis
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 | Headache | ✓ | · | ✓ |
| SD | Mouth ulceration | ✓ | ✓ | ✓ |
| SD | Respiratory tract congestion | ✓ | · | ✓ |
| SD | Sneezing | ✓ | · | ✓ |
| SRO | Axillary pain | ✓ | ✓ | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Lymphadenitis | · | · | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Self-medication | ✓ | ✓ | ✓ |
| SRO | Sleep disorder | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | ○ | ○ | ○ |
✓ active code · ○ coded but marked inactive · blank = not in that release