633-13905-04442
3 vaccinations
3 coded responses
36 check-ins
3 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 66+
- ZIP prefix
- 064 / CT
- Registered
- 2021-03-11
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
-
2021-03-09
Dose 1 — Moderna
-
2021-03-11
Registered in v-safe
- 2021-03-11
- 2021-03-12
- 2021-03-13
- 2021-03-14
- 2021-03-15
- 2021-03-16
- 2021-03-25
- 2021-03-30
-
2021-04-03
Dose 2 — Moderna
-
2021-04-06
Survey response — days 1–6 daily, dose 2MedDRA: Fatigue, Influenza like illness, Pain, Rhinorrhoea, Throat irritation — Feeling: Fair · Fever · Chills, Headache, Fatigue or tirednessFree text: Flue like symptoms, scratchy throat, little bit of a runny nose, a little achy, and tired.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-07
- 2021-04-08
-
2021-04-09
Health check-in — days 1–6 daily, dose 2Feeling: Fair · Fever · Chills, Muscle or body achesAdult check-in
- 2021-04-10
- 2021-04-17
- 2021-04-24
- 2021-05-01
- 2021-05-08
- 2021-05-15
- 2021-07-03
- 2021-10-02
-
2021-10-29
Dose 3 — Pfizer-BioNTech
- 2021-10-29
-
2021-10-30
Survey response — days 1–6 daily, dose 3MedDRA: Unevaluable event — Feeling: GoodFree text: You have me wrongly listed as having the first two vac shots as Moderna. Although when I signed up back in March and was sent to a site in (b)(6) CT to receive the first and second vax's I was given Pfizer rather than the Moderna I was originall.MedDRA releases: 2024-11 · check-in free text available
- 2021-10-31
- 2021-11-01
- 2021-11-02
- 2021-11-03
- 2021-11-04
- 2021-11-05
- 2021-11-12
- 2021-11-19
- 2021-11-26
- 2021-12-03
- 2021-12-10
- 2022-01-28
- 2022-04-29
-
2022-10-29
Survey response — 12 months, dose 3MedDRA: Rash — Feeling: GoodFree text: After receiving the latest Moderna bivalent booster earlier this month my right arm (underside) broke out in a rash. My prior vaccines and boosters we all Pfizer.MedDRA releases: 2024-11 · check-in free text available
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-09 | Moderna | |
| 2 | 2021-04-03 | Moderna | |
| 3 | 2021-10-29 | Pfizer-BioNTech | No |
Free text
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Flue like symptoms, scratchy throat, little bit of a runny nose, a little achy, and tired.
Release 10 — days 1–6 daily, dose 3
Systemic reaction (other): You have me wrongly listed as having the first two vac shots as Moderna. Although when I signed up back in March and was sent to a site in (b)(6) CT to receive the first and second vax's I was given Pfizer rather than the Moderna I was originall.
redacted (b)(6)
Release 12 — 12 months, dose 3
Symptoms: After receiving the latest Moderna bivalent booster earlier this month my right arm (underside) broke out in a rash. My prior vaccines and boosters we all Pfizer.
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 | Rash | · | · | ✓ |
| SRO | Fatigue | ✓ | ✓ | ✓ |
| SRO | Influenza like illness | ✓ | ✓ | ✓ |
| SRO | Pain | ✓ | ✓ | ✓ |
| SRO | Rhinorrhoea | ✓ | ✓ | ✓ |
| SRO | Throat irritation | ✓ | ✓ | ✓ |
| SRO | Unevaluable event | · | · | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release