5Q3-11006-29918
4 vaccinations
5 coded responses
27 check-ins
5 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 557 / MN
- Registered
- 2021-03-15
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-10
Dose 1 — Moderna
-
2021-03-15
Registered in v-safe
- 2021-03-15
- 2021-03-16
- 2021-03-17
- 2021-03-24
- 2021-03-31
-
2021-04-07
Dose 2 — Moderna
-
2021-04-09
Survey response — days 1–6 daily, dose 2MedDRA: Back pain, Eye pain, Paranasal sinus discomfort — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesFree text: Stabbing pains thoracic, lumbar back pain, sinus pressure to include pain behind eyes.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-10
Survey response — days 1–6 daily, dose 2MedDRA: Dyspnoea, Gait disturbance, Gingival pain, Oropharyngeal pain, Teething, Toothache — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activitiesFree text: Sore teeth/gums, transient sore throat, unstable gait, winded easily.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-04-11
Survey response — days 1–6 daily, dose 2MedDRA: Blood pressure increased, Heart rate increased — Feeling: Fair · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness · Be unable to work, Be unable to do your normal daily activitiesFree text: Back to day 1 after vacc, forgot to rpt +HR & +BP.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-12
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Fever · Headache, Fatigue or tirednessAdult check-in
-
2021-04-13
Survey response — days 1–6 daily, dose 2MedDRA: Influenza like illness — Feeling: Good · Headache, Fatigue or tirednessFree text: Expected mild side effects, wasnt prepared for severe flu like symptoms. People I know who have had COVID didnt have as severe symptoms as Ive had with the second dose of COVID fax.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-14
- 2021-04-21
- 2021-04-28
- 2021-05-05
- 2021-05-12
- 2021-05-19
- 2021-07-08
- 2021-10-06
-
2021-11-18
Dose 3 — Moderna
-
2022-04-07
Survey response — 12 months, dose 2MedDRA: Adverse reaction — Feeling: FairFree text: Early seasonal allergy symptoms. No fever.MedDRA releases: 2024-11 · check-in free text available
-
2022-04-11
Dose 4 — Moderna
- 2022-04-30
- 2022-05-02
- 2022-05-09
- 2022-05-16
- 2022-05-23
- 2022-07-11
- 2022-10-11
- 2023-04-13
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-10 | Moderna | |
| 2 | 2021-04-07 | Moderna | |
| 3 | 2021-11-18 | Moderna | No |
| 4 | 2022-04-11 | Moderna | No |
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Stabbing pains thoracic, lumbar back pain, sinus pressure to include pain behind eyes.
Systemic reaction (other): Sore teeth/gums, transient sore throat, unstable gait, winded easily.
Systemic reaction (other): Back to day 1 after vacc, forgot to rpt +HR & +BP.
Systemic reaction (other): Expected mild side effects, wasnt prepared for severe flu like symptoms. People I know who have had COVID didnt have as severe symptoms as Ive had with the second dose of COVID fax.
Release 11 — 12 months, dose 2
Symptoms: Early seasonal allergy symptoms. No fever.
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 | Adverse reaction | · | · | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
| SRO | Blood pressure increased | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | ✓ | ✓ | ✓ |
| SRO | Eye pain | ✓ | ✓ | ✓ |
| SRO | Gait disturbance | ✓ | ✓ | ✓ |
| SRO | Gingival pain | ✓ | ✓ | ✓ |
| SRO | Heart rate increased | ✓ | ✓ | ✓ |
| SRO | Influenza like illness | ✓ | ✓ | ✓ |
| SRO | Oropharyngeal pain | ✓ | ✓ | ✓ |
| SRO | Paranasal sinus discomfort | ✓ | ✓ | ✓ |
| SRO | Teething | ✓ | ✓ | ○ |
| SRO | Toothache | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release