64T-20465-27690
2 vaccinations
6 coded responses
17 check-ins
6 free-text entries
0 call cases
- Sex
- Male
- Age at first dose
- 56-60
- ZIP prefix
- 923 / CA
- Registered
- 2021-04-19
- Relationship
- Self
- Race
- White
- Ethnicity
- Not Hispanic or Latino
Timeline
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2021-03-23
Dose 1 — Moderna
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2021-04-19
Registered in v-safe
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2021-04-19
Survey response — day 21, dose 1MedDRA: COVID-19, Chills, Dyspnoea, Headache, Nausea — Feeling: Fair · Be unable to do your normal daily activitiesFree text: Chills, fever nausea, fatigue, headaches, difficulty breathing and a sore injection arm for a couple of days. I did not seek medical help. I tested positive COVID-19 roughly from June 24, 2020 to roughly September 01, 2020, I was not hospitalized.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-20
Dose 2 — Moderna
- 2021-04-20
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2021-04-21
Health check-in — days 1–6 daily, dose 2Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesAdult check-in
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2021-04-22
Survey response — days 1–6 daily, dose 2MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activitiesFree text: Breathing difficultiesMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-23
Health check-in — days 1–6 daily, dose 2Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, NauseaAdult check-in
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2021-04-24
Survey response — days 1–6 daily, dose 2MedDRA: Back pain, Dyspnoea — Feeling: Fair · Site: Pain · Abdominal pain · Be unable to do your normal daily activitiesFree text: Breath difficulty, moderate & Lower Back pain, moderateMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-25
Survey response — days 1–6 daily, dose 2MedDRA: Back pain, Dyspnoea, Total lung capacity decreased — Feeling: Fair · Muscle or body aches, Nausea · Be unable to do your normal daily activitiesFree text: Lower back pain, moderate & difficulty breathing(decreased lung capacity), moderateMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
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2021-04-26
Survey response — days 1–6 daily, dose 2MedDRA: Dyspnoea — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activitiesFree text: Difficulty taking deep breaths, moderateMedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-04-27
- 2021-05-04
- 2021-05-11
- 2021-05-18
- 2021-05-25
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2021-06-01
Survey response — day 42, dose 2MedDRA: Back pain — Feeling: Good · Be unable to do your normal daily activitiesFree text: Lower back pain.MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
- 2021-07-20
- 2021-10-19
- 2022-04-20
Vaccinations
| Dose | Date | Manufacturer | Co-administered |
|---|---|---|---|
| 1 | 2021-03-23 | Moderna | |
| 2 | 2021-04-20 | Moderna |
Free text
Release 7 — day 21, dose 1
Symptoms: Chills, fever nausea, fatigue, headaches, difficulty breathing and a sore injection arm for a couple of days. I did not seek medical help. I tested positive COVID-19 roughly from June 24, 2020 to roughly September 01, 2020, I was not hospitalized.
Release 7 — days 1–6 daily, dose 2
Systemic reaction (other): Breathing difficulties
Systemic reaction (other): Breath difficulty, moderate & Lower Back pain, moderate
Systemic reaction (other): Lower back pain, moderate & difficulty breathing(decreased lung capacity), moderate
Release 8 — days 1–6 daily, dose 2
Systemic reaction (other): Difficulty taking deep breaths, moderate
Release 8 — day 42, dose 2
Symptoms: Lower back pain.
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 | Back pain | ✓ | ✓ | ✓ |
| SD | Chills | ✓ | ✓ | ✓ |
| SD | COVID-19 | ✓ | ✓ | ✓ |
| SD | Dyspnoea | ✓ | ✓ | ✓ |
| SD | Headache | ✓ | ✓ | ✓ |
| SD | Nausea | ✓ | ✓ | ✓ |
| SRO | Back pain | ✓ | ✓ | ✓ |
| SRO | Dyspnoea | ✓ | ✓ | ✓ |
| SRO | Total lung capacity decreased | ✓ | ✓ | ✓ |
✓ active code · ○ coded but marked inactive · blank = not in that release