5FW-92936-24741
4 vaccinations
4 coded responses
38 check-ins
4 free-text entries
2 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 483 / MI
- Registered
- 2021-02-13
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-12
Dose 1 — Moderna
-
2021-02-13
Registered in v-safe
-
2021-02-13
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2021-02-14
Health check-in — days 1–6 daily, dose 1Feeling: Good · Site: Pain · Fatigue or tirednessAdult check-in
- 2021-02-15
- 2021-02-16
- 2021-02-17
- 2021-02-18
- 2021-02-19
- 2021-02-27
- 2021-03-05
-
2021-03-12
Dose 2 — Moderna
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-18
- 2021-03-19
- 2021-03-26
- 2021-04-02
- 2021-04-11
- 2021-04-16
- 2021-04-23
-
2021-06-12
Survey response — 3 months, dose 2MedDRA: Nervous system disorder, Office visit — Feeling: Good · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professionalFree text: Symptoms: Sciatic problems · Healthcare visit (other): ChiropractorMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-06-12
Report sent to call center — 3 months, dose 2Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional1 call case(s)
- 2021-06-29
-
2021-09-10
Survey response — 6 months, dose 2MedDRA: Paraesthesia, Pruritus — Feeling: GoodFree text: I have an area on my back just below my left side of my neck that has itched since my vaccine shot. I also have a vibration feeling on my left shoulder that comes and goes intermittently. It doesn't hurt. My shot was given on my left shoulder.MedDRA releases: 2024-11 · check-in free text available
-
2021-11-16
Dose 3 — Moderna
- 2022-03-12
-
2022-06-15
Dose 4 — Moderna
-
2022-06-16
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
-
2022-06-17
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Pain, Itching · Muscle or body aches, Fatigue or tirednessAdult check-in
-
2022-06-18
Health check-in — days 1–6 daily, dose 4Feeling: Good · Site: Itching · Fatigue or tirednessAdult check-in
- 2022-06-19
-
2022-06-20
Health check-in — days 1–6 daily, dose 4Feeling: Fair · Site: Itching · Headache, Fatigue or tirednessAdult check-in
- 2022-06-22
- 2022-06-30
- 2022-07-06
- 2022-07-13
-
2022-07-20
Survey response — day 35, dose 4MedDRA: Pruritus — Feeling: GoodFree text: Itching left shoulder where I had the booster.MedDRA releases: 2024-11 · check-in free text available
- 2022-07-28
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2022-12-16
Survey response — 6 months, dose 4MedDRA: Eye disorder, Office visit — Feeling: Good · Get care from a doctor or other healthcare professionalFree text: Symptoms: Need contacts, both eyes . Will be done in . March and April. · Healthcare visit (other): (b)(6) eye center, (b)(6)MedDRA releases: 2024-11 · check-in free text available
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2022-12-16
Report sent to call center — 6 months, dose 4Get care from a doctor or other healthcare professional1 call case(s)
- 2022-12-19
- 2022-12-19
- 2023-06-15
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-12 | Moderna | |
| 2 | 2021-03-12 | Moderna | |
| 3 | 2021-11-16 | Moderna | No |
| 4 | 2022-06-15 | Moderna | No |
Call center
2 call center cases
2 unsuccessful
Free text
Release 9 — 3 months, dose 2
Release 9 — 6 months, dose 2
Symptoms: I have an area on my back just below my left side of my neck that has itched since my vaccine shot. I also have a vibration feeling on my left shoulder that comes and goes intermittently. It doesn't hurt. My shot was given on my left shoulder.
Release 12 — day 35, dose 4
Symptoms: Itching left shoulder where I had the booster.
Release 12 — 6 months, dose 4
Symptoms: Need contacts, both eyes . Will be done in . March and April.
Healthcare visit (other): (b)(6) eye center, (b)(6)
redacted (b)(6)
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 | Office visit | ✓ | ✓ | ✓ |
| SD | Eye disorder | · | · | ✓ |
| SD | Nervous system disorder | ✓ | ✓ | ✓ |
| SD | Paraesthesia | · | · | ✓ |
| SD | Pruritus | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release