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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

  1. 2021-03-23
    Dose 1 — Moderna
  2. 2021-04-19
    Registered in v-safe
  3. 2021-04-19
    Survey response — day 21, dose 1
    MedDRA: COVID-19, Chills, Dyspnoea, Headache, Nausea — Feeling: Fair · Be unable to do your normal daily activities
    Free 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
  4. 2021-04-20
    Dose 2 — Moderna
  5. 2021-04-20
    Health check-in — day 0, dose 2
    Feeling: Good · None
    Adult check-in
  6. 2021-04-21
    Health check-in — days 1–6 daily, dose 2
    Feeling: Poor · Site: Pain · Fever · Chills, Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities
    Adult check-in
  7. 2021-04-22
    Survey response — days 1–6 daily, dose 2
    MedDRA: Dyspnoea — Feeling: Fair · Site: Pain · Headache, Joint pains, Muscle or body aches, Fatigue or tiredness, Nausea · Be unable to do your normal daily activities
    Free text: Breathing difficulties
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-04-23
    Health check-in — days 1–6 daily, dose 2
    Feeling: Good · Site: Pain · Muscle or body aches, Fatigue or tiredness, Nausea
    Adult check-in
  9. 2021-04-24
    Survey response — days 1–6 daily, dose 2
    MedDRA: Back pain, Dyspnoea — Feeling: Fair · Site: Pain · Abdominal pain · Be unable to do your normal daily activities
    Free text: Breath difficulty, moderate & Lower Back pain, moderate
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  10. 2021-04-25
    Survey response — days 1–6 daily, dose 2
    MedDRA: Back pain, Dyspnoea, Total lung capacity decreased — Feeling: Fair · Muscle or body aches, Nausea · Be unable to do your normal daily activities
    Free text: Lower back pain, moderate & difficulty breathing(decreased lung capacity), moderate
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-04-26
    Survey response — days 1–6 daily, dose 2
    MedDRA: Dyspnoea — Feeling: Good · Fatigue or tiredness · Be unable to do your normal daily activities
    Free text: Difficulty taking deep breaths, moderate
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  12. 2021-04-27
    Health check-in — day 7, dose 2
    Feeling: Good · None
    Adult check-in
  13. 2021-05-04
    Health check-in — day 14, dose 2
    Feeling: Good
    Adult check-in
  14. 2021-05-11
    Health check-in — day 21, dose 2
    Feeling: Good
    Adult check-in
  15. 2021-05-18
    Health check-in — day 28, dose 2
    Feeling: Good
    Adult check-in
  16. 2021-05-25
    Health check-in — day 35, dose 2
    Feeling: Good
    Adult check-in
  17. 2021-06-01
    Survey response — day 42, dose 2
    MedDRA: Back pain — Feeling: Good · Be unable to do your normal daily activities
    Free text: Lower back pain.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  18. 2021-07-20
    Health check-in — 3 months, dose 2
    Feeling: Good
    Adult check-in
  19. 2021-10-19
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in
  20. 2022-04-20
    Health check-in — 12 months, dose 2
    Feeling: Fair
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-03-23Moderna
22021-04-20Moderna

Free text

Release 7 — day 21, dose 1

2021-04-19

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

2021-04-22

Systemic reaction (other): Breathing difficulties

2021-04-24

Systemic reaction (other): Breath difficulty, moderate & Lower Back pain, moderate

2021-04-25

Systemic reaction (other): Lower back pain, moderate & difficulty breathing(decreased lung capacity), moderate

Release 8 — days 1–6 daily, dose 2

2021-04-26

Systemic reaction (other): Difficulty taking deep breaths, moderate

Release 8 — day 42, dose 2

2021-06-01

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

FieldPreferred term2021-092023-042024-11
SDBack pain ✓ ✓ ✓
SDChills ✓ ✓ ✓
SDCOVID-19 ✓ ✓ ✓
SDDyspnoea ✓ ✓ ✓
SDHeadache ✓ ✓ ✓
SDNausea ✓ ✓ ✓
SROBack pain ✓ ✓ ✓
SRODyspnoea ✓ ✓ ✓
SROTotal lung capacity decreased ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release