5JT-28800-81813
2 vaccinations
5 coded responses
17 check-ins
5 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 400 / KY
- Registered
- 2021-03-24
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-24
Registered in v-safe
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2021-03-24
Dose 1 — Moderna
- 2021-03-24
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2021-03-25
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Headache, Muscle or body achesAdult check-in
- 2021-03-26
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2021-03-27
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tirednessAdult check-in
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2021-03-28
Survey response — days 1–6 daily, dose 1MedDRA: Neck mass — Feeling: Poor · Site: Pain · Muscle or body aches · Be unable to do your normal daily activitiesFree text: A lump just below my left collar bone. This is opposite side I had my shotMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-03-29
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Muscle or body aches · Be unable to do your normal daily activitiesAdult check-in
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2021-03-30
Health check-in — days 1–6 daily, dose 1Feeling: Fair · Site: Pain · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activitiesAdult check-in
- 2021-03-31
- 2021-04-09
- 2021-04-14
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2021-04-21
Dose 2 — Moderna
- 2021-04-23
- 2021-05-07
- 2021-05-14
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2021-05-19
Survey response — day 28, dose 2MedDRA: Asthenia — Feeling: FairFree text: I dont have a lot of energy and under collar bone now my left side is really sore at timesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-05-26
Survey response — day 35, dose 2MedDRA: Asthenia, Loss of personal independence in daily activities — Feeling: Poor · Be unable to do your normal daily activitiesFree text: I am not able to do my fruit tree maintenance no more than 10 minutes at a time. Weakness in upper back and shoulders. Makes for a long day when you have 32 fruit trees. I have never had this trouble before the covid shotsMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-06-04
Survey response — day 42, dose 2MedDRA: Campylobacter colitis, Campylobacter infection, Emergency care, Lymph node pain — Feeling: Fair · Be unable to workFree text: I was infected with Campylobacter. My Lymph nodes were extremely painful. I had to go to the ER gave me 2 bags of liquids because my immune system could not fight this without antibiotics. I think the vaccine has damaged my immune system.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-07-21
Survey response — 3 months, dose 2MedDRA: Headache, Neck pain, Pre-existing disease — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visitFree text: I am still having high levels of inflammation after recovering from campylobacter. The back Of my head and neck has hurt non stop for the last 2 monthsMedDRA releases: 2024-11 · check-in free text available
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2021-07-21
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)
- 2021-07-27
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-24 | Moderna | |
| 2 | 2021-04-21 | Moderna |
Call center
1 call center case
1 unsuccessful
Free text
Release 6 — days 1–6 daily, dose 1
Systemic reaction (other): A lump just below my left collar bone. This is opposite side I had my shot
Release 8 — day 28, dose 2
Symptoms: I dont have a lot of energy and under collar bone now my left side is really sore at times
Release 8 — day 35, dose 2
Symptoms: I am not able to do my fruit tree maintenance no more than 10 minutes at a time. Weakness in upper back and shoulders. Makes for a long day when you have 32 fruit trees. I have never had this trouble before the covid shots
Release 8 — day 42, dose 2
Symptoms: I was infected with Campylobacter. My Lymph nodes were extremely painful. I had to go to the ER gave me 2 bags of liquids because my immune system could not fight this without antibiotics. I think the vaccine has damaged my immune system.
Release 9 — 3 months, dose 2
Symptoms: I am still having high levels of inflammation after recovering from campylobacter. The back Of my head and neck has hurt non stop for the last 2 months
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 | Asthenia | ✓ | ✓ | ✓ |
| SD | Campylobacter colitis | ○ | ✓ | ○ |
| SD | Campylobacter infection | ✓ | · | ✓ |
| SD | Emergency care | ✓ | ✓ | ✓ |
| SD | Headache | · | · | ✓ |
| SD | Loss of personal independence in daily activities | ✓ | ✓ | ✓ |
| SD | Lymph node pain | ✓ | ✓ | ✓ |
| SD | Neck pain | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SRO | Neck mass | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release