5JR-11457-86171
2 vaccinations
7 coded responses
17 check-ins
7 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 949 / CA
- Registered
- 2021-03-30
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-05
Dose 1 — Moderna
-
2021-03-30
Registered in v-safe
- 2021-03-30
-
2021-04-02
Dose 2 — Moderna
-
2021-04-02
Survey response — day 0, dose 2MedDRA: No adverse event — Feeling: Good · Site: PainFree text: Not yet, its only been a few hoursMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-03
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-04-04
- 2021-04-05
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2021-04-06
Survey response — days 1–6 daily, dose 2MedDRA: No adverse event — Feeling: GoodFree text: Nope. Happy to have gotten the second shot!MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-07
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2021-04-08
Survey response — days 1–6 daily, dose 2MedDRA: Diarrhoea, Dyspnoea, Feeling cold, Feeling hot, Feeling of body temperature change, Presyncope, Somnolence, Syncope, Vaccine positive rechallenge — Feeling: Fair · Fever · Chills, Headache, Fatigue or tiredness, Nausea, Diarrhea · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: This was very strange. About 5 days after the second shot, the same time this happened after the first shot, I experienced explosive diarrhea, near fainting, and serious difficulty breathing. Finally, after an hour, I was able to lie quietly and slept for about 4 hours in the middle of the afternoon. First I was too hot, then I couldn't get warm. I feel OK now, though.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-09
Survey response — day 7, dose 2MedDRA: Dizziness, Dyspnoea, Heart rate increased, Loss of consciousness, Syncope — Feeling: Good · HeadacheFree text: Yesterday: , which Id rate severe: dizziness, feeling very fainton the point of passing out. Also, rapid heartbeat, very troublesome breathing.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-16
- 2021-04-23
- 2021-04-30
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2021-05-07
Survey response — day 35, dose 2MedDRA: Movement disorder — Feeling: Poor · Be unable to work, Be unable to do your normal daily activitiesFree text: For reasons I cant explain, and which may have nothing to do with the vaccine, I have experienced gout-like symptoms that now make it difficult to walk on one leg. I am contacting my doctor.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-14
Survey response — day 42, dose 2MedDRA: Gout — Feeling: FairFree text: Still experiencing the after effects of my first-ever bout of gout. Not worsening, just hanging on. Probably not related to vaccine.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-07-02
- 2021-10-06
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2022-04-02
Survey response — 12 months, dose 2MedDRA: Influenza like illness, Pain in extremity — Feeling: FairFree text: Mild flu-like symptoms today and a slightly sore arm. I got my second booster yesterday.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-05 | Moderna | |
| 2 | 2021-04-02 | Moderna |
Free text
Release 6 — day 0, dose 2
Systemic reaction (other): Not yet, its only been a few hours
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Nope. Happy to have gotten the second shot!
Systemic reaction (other): This was very strange. About 5 days after the second shot, the same time this happened after the first shot, I experienced explosive diarrhea, near fainting, and serious difficulty breathing. Finally, after an hour, I was able to lie quietly and slept for about 4 hours in the middle of the afternoon. First I was too hot, then I couldn't get warm. I feel OK now, though.
Release 7 — day 7, dose 2
Systemic reaction (other): Yesterday: , which Id rate severe: dizziness, feeling very fainton the point of passing out. Also, rapid heartbeat, very troublesome breathing.
Release 8 — day 35, dose 2
Symptoms: For reasons I cant explain, and which may have nothing to do with the vaccine, I have experienced gout-like symptoms that now make it difficult to walk on one leg. I am contacting my doctor.
Release 8 — day 42, dose 2
Symptoms: Still experiencing the after effects of my first-ever bout of gout. Not worsening, just hanging on. Probably not related to vaccine.
Release 11 — 12 months, dose 2
Symptoms: Mild flu-like symptoms today and a slightly sore arm. I got my second booster yesterday.
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 | Gout | ✓ | ✓ | ✓ |
| SD | Influenza like illness | · | · | ✓ |
| SD | Movement disorder | ✓ | ✓ | ✓ |
| SD | Pain in extremity | · | · | ✓ |
| SRO | Diarrhoea | ✓ | ✓ | ✓ |
| SRO | Dizziness | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | ✓ | ✓ | ✓ |
| SRO | Feeling cold | ✓ | ✓ | ○ |
| SRO | Feeling hot | ✓ | ✓ | ○ |
| SRO | Feeling of body temperature change | · | · | ✓ |
| SRO | Heart rate increased | ✓ | ✓ | ✓ |
| SRO | Loss of consciousness | ✓ | ✓ | ✓ |
| SRO | No adverse event | ✓ | ✓ | ✓ |
| SRO | Presyncope | · | · | ✓ |
| SRO | Somnolence | · | · | ✓ |
| SRO | Syncope | ✓ | ✓ | ✓ |
| SRO | Vaccine positive rechallenge | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release