5PL-30101-68262
6 vaccinations
6 coded responses
76 check-ins
3 free-text entries
1 call case
- Sex
- Male
- Age at first dose
- 61-65
- ZIP prefix
- 601 / IL
- Registered
- 2021-02-12
- Relationship
- Self
- Race
- Black or African American
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-02-12
Registered in v-safe
-
2021-02-12
Dose 1 — Moderna
- 2021-02-12
- 2021-02-13
- 2021-02-14
- 2021-02-15
- 2021-02-16
- 2021-02-18
- 2021-02-19
- 2021-02-26
- 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
- 2021-04-10
- 2021-04-16
- 2021-04-23
- 2021-06-11
- 2021-09-10
-
2021-11-18
Dose 3 — Moderna
- 2021-11-18
- 2021-11-19
- 2021-11-20
- 2021-11-21
- 2021-11-22
- 2021-11-23
- 2021-11-24
- 2021-11-25
- 2021-12-02
- 2021-12-09
- 2021-12-16
- 2021-12-23
- 2021-12-30
- 2022-02-17
-
2022-04-15
Dose 4 — Moderna
- 2022-04-15
-
2022-04-16
Survey response — days 1–6 daily, dose 4MedDRA: Rhinorrhoea — Feeling: Good · Site: PainFree text: Had a runny nose for just over an hour, that I didn't have yesterday. Not sure if it's vaccine-related.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-17
Survey response — days 1–6 daily, dose 4MedDRA: Rhinorrhoea — Feeling: GoodFree text: Slight runny nose - better than yesterday (less frequent & less mucous)MedDRA releases: 2024-11 · check-in free text available
- 2022-04-18
- 2022-04-19
- 2022-04-20
- 2022-04-21
- 2022-04-22
- 2022-04-29
- 2022-05-06
- 2022-05-13
- 2022-05-20
- 2022-05-27
-
2022-07-15
Survey response — 3 months, dose 4MedDRA: Chills, Cough, Rhinorrhoea, SARS-CoV-2 test positive — Feeling: Good · Be unable to work or attend school, Be unable to do your normal daily activitiesFree text: Positive PCR test on 7/12/2022. Had moderate symptoms from 7/8-7/13 chills, runny nose, and occasional cough. This form will NOT let me input the 7/12 date below-some input problem with the year. DISREGARD THE No ANSWER BELOW I DID HAVE COVIDMedDRA releases: 2024-11 · check-in free text available
-
2022-09-24
Dose 5 — ModernaCo-administered: Flu
- 2022-09-27
- 2022-09-28
- 2022-09-29
- 2022-09-30
- 2022-10-01
- 2022-10-08
- 2022-10-15
- 2022-10-22
- 2022-10-30
- 2022-11-05
- 2022-12-24
- 2023-03-25
-
2023-05-07
Dose 6 — Pfizer-BioNTechCo-administered: Pneumonia
- 2023-05-08
-
2023-05-09
Survey response — days 1–6 daily, dose 6MedDRA: Chills — Feeling: Good · Site: Pain · ChillsMedDRA releases: 2024-11
- 2023-05-10
- 2023-05-11
- 2023-05-12
- 2023-05-13
- 2023-05-14
- 2023-05-21
- 2023-05-28
-
2023-06-04
Survey response — day 28, dose 6MedDRA: Gastrointestinal disorder, Hospitalisation, Neoplasm malignant, Surgery — Feeling: Good · Be unable to work or attend schoolMedDRA releases: 2024-11
-
2023-06-11
Survey response — day 35, dose 6MedDRA: Abdominal pain, Intestinal mass, Mass excision — 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 · Emergency room or emergency department visit, HospitalizationMedDRA releases: 2024-11
-
2023-06-11
Call case (no matching report) — SuccessfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-06-12
-
2023-06-12
Call successfulNot applicable – Participant does not believe symptoms are related to vaccine and does not wish to fill
- 2023-06-18
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-02-12 | Moderna | |
| 2 | 2021-03-12 | Moderna | |
| 3 | 2021-11-18 | Moderna | No |
| 4 | 2022-04-15 | Moderna | No |
| 5 | 2022-09-24 | Moderna | Flu |
| 6 | 2023-05-07 | Pfizer-BioNTech | Pneumonia |
Call center
1 call center case
1 successful
Free text
Release 11 — days 1–6 daily, dose 4
Systemic reaction (other): Had a runny nose for just over an hour, that I didn't have yesterday. Not sure if it's vaccine-related.
Systemic reaction (other): Slight runny nose - better than yesterday (less frequent & less mucous)
Release 12 — 3 months, dose 4
Symptoms: Positive PCR test on 7/12/2022. Had moderate symptoms from 7/8-7/13 chills, runny nose, and occasional cough. This form will NOT let me input the 7/12 date below-some input problem with the year. DISREGARD THE No ANSWER BELOW I DID HAVE COVID
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 | Abdominal pain | · | · | ✓ |
| SD | Chills | · | · | ✓ |
| SD | Cough | · | · | ✓ |
| SD | Gastrointestinal disorder | · | · | ✓ |
| SD | Hospitalisation | · | · | ✓ |
| SD | Intestinal mass | · | · | ✓ |
| SD | Mass excision | · | · | ✓ |
| SD | Neoplasm malignant | · | · | ✓ |
| SD | Rhinorrhoea | · | · | ✓ |
| SD | SARS-CoV-2 test positive | · | · | ✓ |
| SD | Surgery | · | · | ✓ |
| SRO | Chills | · | · | ✓ |
| SRO | Rhinorrhoea | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release