5YH-15565-84667
4 vaccinations
8 coded responses
44 check-ins
7 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 787 / TX
- Registered
- 2021-01-16
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Registered dependents
KBT-25014-51702
Child or adolescent in my care · Male · 2021-10-23
Timeline
-
2021-01-16
Registered in v-safe
-
2021-01-16
Dose 1 — Moderna
- 2021-01-16
-
2021-01-17
Survey response — days 1–6 daily, dose 1MedDRA: Headache — Feeling: GoodFree text: Slight headache last nightMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-18
- 2021-01-19
- 2021-01-21
-
2021-01-22
Survey response — days 1–6 daily, dose 1MedDRA: Chills, Poor quality sleep — Feeling: GoodFree text: Felt chills during the night which woke me up. Then fell back to sleep. Ok in the morningMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
-
2021-01-23
Survey response — day 7, dose 1MedDRA: Chills, Diabetes mellitus, Pre-existing disease — Feeling: GoodFree text: Some slight chills during the night,but I attribute that to being a diabetic.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-01-30
- 2021-02-06
- 2021-02-13
- 2021-02-20
-
2021-02-21
Dose 2 — Moderna
-
2021-02-25
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Site: Pain · Muscle or body achesAdult check-in
-
2021-02-26
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Fever · HeadacheAdult check-in
-
2021-02-27
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-02-28
-
2021-03-07
Survey response — day 14, dose 2MedDRA: Chills — Feeling: FairFree text: Slight chills in the evenings.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-03-14
- 2021-03-21
- 2021-03-28
- 2021-04-04
- 2021-05-23
- 2021-08-22
-
2021-10-23
Dose 3 — Moderna
-
2021-10-23
Survey response — day 0, dose 3MedDRA: Blood pressure decreased — Feeling: Fair · Muscle or body aches, Fatigue or tirednessFree text: Low BP warning 47-50 (Apple arch)MedDRA releases: 2024-11 · check-in free text available
-
2021-10-24
Health check-in — days 1–6 daily, dose 3Feeling: Fair · Site: Pain · Muscle or body achesAdult check-in
-
2021-10-25
Health check-in — days 1–6 daily, dose 3Feeling: Good · Site: Pain · Muscle or body achesAdult check-in
- 2021-10-26
- 2021-10-27
-
2021-10-28
Health check-in — days 1–6 daily, dose 3Feeling: Good · Joint pains, Muscle or body achesAdult check-in
- 2021-10-30
-
2021-11-06
Survey response — day 14, dose 3MedDRA: Dyspnoea, Middle insomnia, Pre-existing disease, Restlessness — Feeling: GoodFree text: Woke up during the night(last night) with difficulty breathing. I use a Cpap device. I tried relaxing mentally and that seemed to calm me down, fell back to sleep with no problems. I do have AFib and take Diltiazam XT 120mg.MedDRA releases: 2024-11 · check-in free text available
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2021-11-13
Survey response — day 21, dose 3MedDRA: Impaired work ability, Vertigo — Feeling: Good · Be unable to work or attend schoolFree text: 2 or 3 times I've experienced "the spins." They go away after 30 min or so, but the problem affects my work. I'm not sure if the problem is related to the vaccine, since I've not experienced any problems with the first two doses.MedDRA releases: 2024-11 · check-in free text available
- 2021-11-20
- 2021-11-27
- 2021-12-04
- 2022-01-22
-
2022-04-07
Dose 4 — Moderna
- 2022-04-15
- 2022-04-21
- 2022-04-28
- 2022-05-05
- 2022-05-12
- 2022-05-19
- 2022-07-07
- 2022-10-06
-
2023-04-07
Survey response — 12 months, dose 4MedDRA: Medical counselling, Physiotherapy, Toe amputation — Feeling: GoodMedDRA releases: 2024-11
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-01-16 | Moderna | |
| 2 | 2021-02-21 | Moderna | |
| 3 | 2021-10-23 | Moderna | No |
| 4 | 2022-04-07 | Moderna | No |
Free text
Release 2 — days 1–6 daily, dose 1
Systemic reaction (other): Slight headache last night
Systemic reaction (other): Felt chills during the night which woke me up. Then fell back to sleep. Ok in the morning
Release 2 — day 7, dose 1
Systemic reaction (other): Some slight chills during the night,but I attribute that to being a diabetic.
Release 5 — day 14, dose 2
Symptoms: Slight chills in the evenings.
Release 10 — day 0, dose 3
Systemic reaction (other): Low BP warning 47-50 (Apple arch)
Release 10 — day 14, dose 3
Symptoms: Woke up during the night(last night) with difficulty breathing. I use a Cpap device. I tried relaxing mentally and that seemed to calm me down, fell back to sleep with no problems. I do have AFib and take Diltiazam XT 120mg.
Release 10 — day 21, dose 3
Symptoms: 2 or 3 times I've experienced "the spins." They go away after 30 min or so, but the problem affects my work. I'm not sure if the problem is related to the vaccine, since I've not experienced any problems with the first two doses.
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 | Chills | ✓ | ✓ | ✓ |
| SD | Dyspnoea | · | · | ✓ |
| SD | Impaired work ability | · | · | ✓ |
| SD | Medical counselling | · | · | ✓ |
| SD | Middle insomnia | · | · | ✓ |
| SD | Physiotherapy | · | · | ✓ |
| SD | Pre-existing disease | · | · | ✓ |
| SD | Restlessness | · | · | ✓ |
| SD | Toe amputation | · | · | ✓ |
| SD | Vertigo | · | · | ✓ |
| SRO | Blood pressure decreased | · | · | ✓ |
| SRO | Chills | ✓ | ✓ | ✓ |
| SRO | Diabetes mellitus | ○ | ✓ | ○ |
| SRO | Headache | ✓ | ✓ | ✓ |
| SRO | Poor quality sleep | ✓ | ✓ | ✓ |
| SRO | Pre-existing disease | ✓ | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release